Fillable Printable Labor Standards Investigation Summary Sheet

Labor Standards Investigation Summary Sheet

LABOR STANDARDS INVESTIGATION SUMMARY SHEET

REPORTING OFFICE CONTRACT AMOUNT DATE OF CONTRACT

TYPE OF CONTRACT

FIXED PRICE CPFF

OTHER (Specify)

CONTRACTOR'S NAME AND ADDRESS (Include ZIP Code) EMPLOYER'S NAME AND ADDRESS (Include ZIP Code)

(If other than prime contractor)

PROJECT AND LOCATION

DESCRIPTION OF WORK

BASIS FOR INVESTIGATION

WAGE DETERMINATION NUMBER WAGE DETERMINATION DATE

NATURE AND EXTENT OF VIOLATION

NO. EMPLOYEES INVOLVED ARE VIOLATIONS CONSIDERED WILLFUL? COPELAND ACT VIOLATIONS

CONSTRUCTION WAGE RATE

REQUIREMENTS STATUTE

UNDERPAYMENTS

CWHSS* UNDERPAYMENTS CWHSS * LAW VIOLATIONS

CORRECTIVE ACTIONS TAKEN

RESTITUTION MADE AMOUNT OF RESTITUTION CONTRACTORS PAYMENT WITHHELD

WITHHELD FOR CONSTRUCTION WAGE

RATE REQUIREMENTS STATUTE

VIOLATIONS

WITHHELD FOR CWHSS* UNDERPAYMENTS WITHHELD FOR CWHSS* VIOLATIONS

REMARKS

PREPARED BY

DATE

*Contract Work Hours and Safety Standards Statute

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is usable

STANDARD FORM 1446 (REV. 4/2013)

Prescribed by GSA-FAR (48 CFR) 53.222(h)

TITLE SIGNATURE

$ $

Yes No

Yes No Yes No

Yes No

CONTRACT NUMBER