Downloads
Worker information form for Davis-Bacon records
A one-page form to complete at hire that captures every field 29 CFR 5.5(a)(3)(i) requires in your records, including the phone number and email address added in 2023, and the fields that never go on the payroll.
Download the PDFFree. No email. One page, US Letter.
Complete one per worker and file it with the payroll records, not with the payrolls you submit. The shaded fields are required in your records and prohibited on the weekly WH-347.
Identity (records only; never on the payroll)
- Full legal name (last, first, middle)
- Social Security numberRecords only. The payroll carries the identifying number below.
- Home address
- Telephone numberRequired in records since October 23, 2023
- Email addressRequired in records since October 23, 2023
- Date of hire
On the payroll
- Identifying number assigned (employee ID or last 4 of SSN); use the same number every week
- Classification(s) of work to be performed, as written on the wage determination
- Journeyworker or registered apprentice
Apprentices only
- Program name and registration agency (Office of Apprenticeship or state agency)
- Program registration number
- Worker's individual registration number and date
- Current period and percentage of journeyworker rate
- Program rule for fringe (full determination fringe / same percentage / stated amount)
Pay and benefits
- Basic hourly rate to be paid
- Fringe: plans enrolled (name, type) and hourly credit; cash in lieu per hour
- Voluntary deductions authorized in writing (type, amount, date of authorization)
Signatures
- Worker signature and date
- Prepared by (name, title) and date
Sources
Checked against the regulations 2026-09-07. Not legal advice; your contract and the wage determination control.