Missouri Labor | Prevailing Wage Complaint Form (PWC)

For Workers on Public Works Projects

Sections 290.210-290.340, RSMo

Sections 292.675, RSMo 10 Hour Construction Safety Training

To mail, print and complete this form and send to:

Division of Labor Standards

Attn: Prevailing Wage Program

P.O. Box 449, Jefferson City, MO 65102-0449

Phone: 573-751-3403 Fax: 573-751-3721

Email: prevailingwage@labor.mo.gov

www.labor.mo.gov/DLS/prevailingwage

When using this form, please use one of the following web browsers: Microsoft Edge, Google Chrome, or Mozilla Firefox.

Complainant Information

* The "Asterisk" Denotes Required Field

Salutation

First Name

Last Name

Suffix

Date

12/21/2024

Address

City

State

Zip Code

Day Phone No.

Alternate Phone No.

Email Address

Confirm Email

~ Please provide email address for confirmation and correspondence about this complaint.

Are You: Public BodyProject ContractorProject SubcontractorProject Worker

Is total project cost over $75,000?

Yes

Type of Complaint

Check Type of Complaint

Project Identification - Complaint Against

Name of Contractor (Employer)

Name of business as shown on your payroll check

Address

City

State

Zip Code

County

Phone No.

Alternate Phone No.

General (Prime) Contractor

Subcontractor

Are you currently employed by this contractor?

Yes

Type of Project

Building

Heavy

Highway

Project Name

Project Location

City

County

Contracting Public Body (who is this job for)?

Project Start and End Date

From?

To?

Pursuant to RSMo. 290.290 MODLS can only pursue administrative action for one (1) year from final project payout.

Complaint Summary & Supporting Documentation

Supporting Documentation

Check stubs/copies of payroll checks

Photos/pictures of project/work performed

Other information (any supporting documentation)

Attachments must not exceed 20 MB and must be one of the following types: .doc, .docx, .xls, .xlsx, .txt, .jpg, .jpeg, or .png

If you are unable to attach the documentation electronically, please indicate below in the "Summary of Complaint" a brief description of documentation you have. An investigator may contact you and ask to have it mailed or faxed to our agency if the documentation is needed.

Summary of Complaint Max # of Characters: 2000

By entering my name and submitting this electronically, I do hereby affirm under penalties of perjury that the above-stated information is true and correct to the best of my knowledge, information, and belief.

First Name

Last Name

Division of Labor StandardsPrevailing Wage Complaint Form

For Workers on Public Works Projects

Division of Labor Standards
Prevailing Wage Complaint Form