Monthly Labor Summary Report Contractor: For Month Ending: Address: Contractor No.: Contract No.: Project Status: No Work Suspended: Completed: Ethnic Last 4 Digits Work Total Employee Name (type or print) of S.S. No. Sex1 2 Class3 Hours First M.I. Last Total Hours: Date: Signature of Contractor 1 Sex: M Male F Female – – Ethnic Group: 1 White 2 Black 3 Hispanic 4 American Indian / Alaskan Native 5 Asian / Pacific Islander – – – – – OF Officials (Managers) SU Supervisors FO Foremen CL - Clerical CA Carpenters – – – – EO Equipment Operator ME Mechanics TD Truck Driver IW Iron Worker PA Painter – – – – – 3 Work Class: CM Cement Mason EL Electrician PP Pipe Fitter/ Plumber TE Technical LA Laborer – – – – – OT - Other 4 Employee Status: O Owner Operator J Journeyman C Company A Apprentice T Trainee – – – – – A certified copy of each monthly report must be submitted by the prime contractor and each subcontractor no later than the 10th day of the next Note: month. The Department of Transportation is requesting disclosure of information necessary to accomplish the statutory purpose as outlined under 23CFR part 230 and CFR 41 part 60.4 and the Illinois Human Rights Act. Disclosure of this information is REQUIRED. Failure to comply may result in the withholding of payments to the Contractor, and/or cancellation, termination, or suspension of the contract in whole or in part.
Monthly Labor Summary Report Contractor: For Month Ending: Address: Contractor No.: Contract No.: Project Status: No Work Suspended: Completed: Last 4 Digits of S.S. No. Employee Name (type or print) First M.I. Last Sex1 Ethnic Work Class3 Total Hours Total Hours: Date: Signature of Contractor 1 Sex: M – Male F – Female 2 Ethnic Group: 1 – White 2 – Black 3 – Hispanic 4 – American Indian / Alaskan Native 5 – Asian / Pacific Islander 3 Work Class: OF – Officials (Managers) SU – Supervisors FO – Foremen CL - Clerical CA – Carpenters EO – Equipment Operator ME – Mechanics TD – Truck Driver IW – Iron Worker PA – Painter CM – Cement Mason EL – Electrician PP – Pipe Fitter/ Plumber TE – Technical LA – Laborer OT - Other 4 Employee Status: O – Owner Operator J – Journeyman C – Company A – Apprentice T – Trainee Note: A certified copy of each monthly report must be submitted by the prime contractor and each subcontractor no later than the 10th day of the next month. The Department of Transportation is requesting disclosure of information necessary to accomplish the statutory purpose as outlined under 23CFR part 230 and CFR 41 part 60.4 and the Illinois Human Rights Act. Disclosure of this information is REQUIRED. Failure to comply may result in the withholding of payments to the Contractor, and/or cancellation, termination, or suspension of the contract in whole or in part.
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