ࡱ>    )` Ubjbj 4JQjjj88jj[lp4pppr/ssLگܯܯܯܯܯܯ$Ihtq"rttpp1MvMvMvtj8ppگMvtگMvMvlvpl hn=jyt*^|+0[0F=7u=Tv=vttMvtttttu^ttt[tttt?DD%D Employee Name: _______________________________________Office ________________________ Fair Labor Standards Act (FLSA) Exempt/Non-Exempt Checklist Instructions: After completing the survey please check the boxes below that apply to the above named employee  FORMCHECKBOX  None of the exemptions apply to the above named employee  FORMCHECKBOX  The following exemption applies to the above named employee  FORMCHECKBOX  Executive Exemption: pages 1 2  FORMCHECKBOX  Administrative Exemption: pages 4 6  FORMCHECKBOX  Professional Exemption: pages 7 - 9  FORMCHECKBOX  Computer Exemption: page 10 Executive Exemption Please read the following information provided to assist you in answering each of the questions at the end of the narratives. If the questions are all the questions are answered yes, the employee meets the executive exemption test. Question No. 1: Does the employee receive a salary of at least $455 per week? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Duties and Responsibilities Management duties include interviewing, selecting and training of employees, setting and adjusting their rates of pay and hours of work; directing their work; maintaining their production or sales records for use in supervision or control; appraising their productivity and efficiency for the purpose of recommending promotions or other changes in their status; handling their complaints and grievances and disciplining them when necessary; planning the work; determining the techniques to be used; proportioning the work among the employees; determining the types of materials, supplies, machinery or tools to be used, or merchandise to be bought, stocked or sold; controlling the flow and distribution of materials or merchandise and supplies; providing for the safety of employees and property. Primary duty generally means the principal or most important duty the employee performs (Management) When an employee spends less than the majority of his/her time performing management functions, he/she may still be considered an executive depending upon other factors such as: The relative importance of the managerial duties as opposed to the other types of duties; The frequency with which the employee exercises discretionary powers; The employees relative freedom from supervision; and The relationship between the employees salary and the wages paid to other employees who perform the same kind of non-exempt work performed by the supervisor. Employee must direct a unit of employees (at least 2) with a permanent status-continuing function, not merely a collection of employees assigned to complete a project. Consider what percentage of time employee spends performing similar duties to those completed by subordinates. If significant administrative or professional duties are performed, consider the combination exemption. If fewer than six subordinates are supervised, examine primary duty very closely (i.e., employee turnover, contacts with internal and external customers, maturity of functional area). Question No. 2: Is the employees primary duty the management of a customarily recognized department? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Supervision Joint or shared supervision with another exempt classified employee is insufficient. Supervision in the regular managers absence is insufficient. Question No. 3: Do the employees duties include the supervision of two or more employees or the equivalent every week? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Authority Are suggestions and recommendations part of the employees job duties? Are recommendations frequently made or requested? Are recommendations frequently relied upon by management? Do the suggestions involve employees the executive regularly directs? Question No. 4: Does the employee have the authority to hire or fire assigned employees? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Question No. 5: Are the employees recommendations concerning hiring, firing, advancement, promotion or other change given particular weight? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Administrative Exemption Please read the following information provided to assist you in answering each of the questions at the end of the narratives. If questions 1, 2 and 3 or 1 and 4 are all answered yes, the employee meets the administrative exemption test. Salary Question No. 1: Does the employee receive a salary of at least $455 per week or the entry level for a professional instructor in the case of academic administrative personnel? Yes  FORMCHECKBOX  No  FORMCHECKBOX  The administrative operations of the business include: YesNoYesNoTaxSafety and HealthFinancePersonnel ManagementAccountingHuman ResourcesBudgetingEmployee BenefitsAuditingLabor RelationsInsurancePublic RelationsQuality ControlGovernment RelationsPurchasingComputer NetworkAdvertisingInternet and Database AdministrationMarketingLegal and Regulatory ComplianceResearchLabor Relations Administrative duties do not include routine or structured tasks such as bookkeeping, data tabulation or clerical duties. The administrative work must be of substantial importance to the management or operation of the business, such as work affecting the development of policies or responsibilities to execute or carry out policy. To qualify as a primary duty, the employees principal or most important duty must involve performing the high-level administrative functions. When an employee spends less than the majority of his/her time performing high-level administrative functions, the employee may qualify under the administrative exemption if: The relative importance of the high-level administrative duties is greater than the other types of duties; The employee frequently exercises discretionary powers; The employees salary is distinguishable from the wages paid to other employees who perform the same kind of non-exempt work. Question No. 2: Does the employees primary duty consist of the performance of office or non-manual work directly related to management policies or general business operations (i.e., administrative work) of the employer or its customers, as opposed to primarily involving production of sales, goods or services? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Discretion and Independent Judgment The employee must exercise discretion and independent judgment with respect to matters of significance as opposed to daily routine decisions Independent judgment and discretion involves the comparison and evaluation of possible courses of conduct and having the authority to make an independent choice, free from immediate direction with respect to matters of significance. (Does not include the use of manuals, guidelines or software packages to make determinations). The exercise of independent judgment and discretion includes the use of skill in applying techniques, procedures or special standards. Discretion and Independent Judgment will depend on several considerations: YesNoDoes the employee have authority to formulate, affect, interpret or implement management policies or operating practices   FORMCHECKBOX   FORMCHECKBOX Does the employee carry out major assignments in conducting the operations of the business?  FORMCHECKBOX   FORMCHECKBOX Does the employee perform work that affects business operations to a substantial degree, even if the employees assignments are related to operation of a particular segment of the business?  FORMCHECKBOX   FORMCHECKBOX Does the employee have authority to commit the employer in matters that have significant financial impact?  FORMCHECKBOX   FORMCHECKBOX Does the employee have authority to waive or deviate from established policies and procedures without prior approval?  FORMCHECKBOX   FORMCHECKBOX Does the employee have authority to negotiate and bind the company on significant matters?  FORMCHECKBOX   FORMCHECKBOX Does the employee provide consultation or expert advice to management?  FORMCHECKBOX   FORMCHECKBOX Does the employee participate in planning long or short term business objectives?  FORMCHECKBOX   FORMCHECKBOX Does the employee investigate and resolve matters of significance on behalf of management?  FORMCHECKBOX   FORMCHECKBOX Does the employee represent the company in handling complaints, arbitrating disputes or resolving grievances?  FORMCHECKBOX   FORMCHECKBOX  Does the employee make recommendations to management on policies and procedures?  FORMCHECKBOX   FORMCHECKBOX Does the employee conduct independent investigation and resolution of issues without prior approval?  FORMCHECKBOX   FORMCHECKBOX Does the employee develop guidebooks, manuals or other policies and procedures for the employer or the employers customers?  FORMCHECKBOX   FORMCHECKBOX Does the employee provide personal responsibilities, trouble shooting or problem solving activities on behalf of management?  FORMCHECKBOX   FORMCHECKBOX Does the employee use personalized communication techniques?  FORMCHECKBOX   FORMCHECKBOX Does the employee provide primary contact to public or customers on behalf of the employer?  FORMCHECKBOX   FORMCHECKBOX Does the employee have the duty to anticipate competitive products or services and distinguish from them from competitors products or services?  FORMCHECKBOX   FORMCHECKBOX Does the employee advertise, do promotional work or coordinate departments  FORMCHECKBOX   FORMCHECKBOX Does the employee set requirements or other activities for, or on behalf of, the employer or employers clients or customers?  FORMCHECKBOX   FORMCHECKBOX  Discretion and independent judgment is not: Applying knowledge, following prescribed procedures, or determining or determining which procedures to follow. Determining whether specified standards have been satisfied, even if there is some leeway in reaching a conclusion; Performing inspection functions by following established techniques and procedures with skills acquired through special training or experience; Formulating recommendations based upon the development of facts concerning conformity with a known standard; Comparing items based upon established standards, known through experience or written manuals; Screening applicants or conducting interviews to determine satisfaction of certain minimum qualifications; Making decisions that do not commit the employer is substantial respects financially or otherwise; or Negotiating settlements with policy holders where the individual is not given reasonable latitude in carrying on those negotiations. Question No. 3: Do the employees duties include work requiring the exercise of discretion and judgment? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Academic Administrative Exemption An educational institution includes an elementary or secondary school system, an institution of higher education and special schools for mentally or physically disabled or gifted children, with no distinction between public and private organizations. Academic administrative activities mean work directly relate to the academic operations and academic functions of the institution, such as administration of curriculum, examination of quality and methods of instruction, measurement of learning potential and achievement, maintenance of academic and grading standards and other aspects of a teaching program. Academic administrative responsibilities do not include building management and maintenance, supporting the health of students or activity performed by social workers, psychologists or even dieticians. Question No 4: Does the employees primary duty consist of the performance of office or non-manual work, directly related to academic instruction or training in an education institution? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Professional Exemption (Learned Professions) Please read the following information provided to assist you in answering each of the questions at the end of the narratives. If questions 1, 2, and 3 or 1 and 4 are answered yes, the employee meets the professional exemption test. Question No. 1: Does the employee receive a salary of at least $455 per week? (Note: Those whove completed the educational requirements for a law or medical degree need not meet the minimum salary requirement. Also teachers need not be certified or meet the minimum salary requirement to qualify as learned professionals.) Yes  FORMCHECKBOX  No  FORMCHECKBOX  Knowledge or Education Required Knowledge must not be restricted to the mechanical arts. Requisite knowledge must be customarily acquired by a prolonged course of specialized intellectual study. In some subjects, however, the specialized intellectual study may be acquired by a combination of intellectual study and work experience. Professions covered by the exemption include: lawyers, doctors, dentists, teachers, registered nurses, (not LPNs), accounting (not bookkeepers), actuarial computation, clergy, engineering, (have engineering degrees or the or perform work of the sort usually performed by licensed professional engineers), education and various types of physical, chemical and biological sciences, (but not technicians), pharmacists and other employees who perform work of an advanced knowledge similar to that historically associated with the traditional learned professions. Professional exempt work means work that is predominantly intellectual, requires specialized education, and involves the exercise of discretion and judgment. Professionally exempt workers must have education beyond high school, and usually beyond college, in fields that are distinguished from (more academic than) the mechanical arts or skilled trades. Advanced degrees are the most common measure of this, but are not absolutely necessary if an employee has attained a similar level of advanced education through other means (and performs essentially the same kind of work as similar employees who do not have advanced degrees). Primary duty generally indicates that the principal and most important part of the job is pursuing the profession. Question No. 2: Does the employee perform work requiring knowledge of an advanced type in a recognized field of science or learning? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Discretion and judgment YesNoDoes the employee make decisions to depart from prescribed standards or permitted tolerances?Does the employee make decisions that affect the operational policies of the employees department?Does the employee formulate recommendations to a customer for the purchase of securities?Does the employee make decisions in connection with negotiations where the individual is given reasonable latitude in carrying on those discussions, which are binding on the employer?Does the employee formulate recommendations, even if management personnel must review and accept the recommendation prior to implementation?Does the employee formulate and participate in the formulation of policy for the business unit?Does the employee have broad authority to commit the employer in substantial respects financially. Discretion and judgment is not: Applying knowledge, following prescribed procedures or determining which procedure to follow; Determining whether specified standards have been satisfied, even if there is some leeway in reaching a conclusion; Performing inspection functions by following established techniques and procedures with skills acquired through special training or experience; Formulating recommendations based upon the development of facts concerning conformity with a known standard; Comparing items based upon established standards, known through experience or written manuals; Screening applicants or conducting interviews to determine satisfaction of certain minimum qualifications; or Making decisions to do not commit the employer in substantial respects financially or otherwise. Question No. 3: Does the employees duties include work requiring consistent exercise of discretion and judgment? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Primary Duties - Creative Professional Some employees may also perform creative professional job duties which are exempt. This classification applies to such as actors, musicians, composers, writers, cartoonists, and some journalists. It is meant to cover employees in the type of jobs whose work requires invention, imagination, originality or talent; who contribute a unique interpretation or analysis. YesNoIs the work a recognized field of artistic or creative endeavor to include music, writing, acting and the graphic arts?Does the work require intelligence, diligence and accuracy with the individual having broad leeway to develop an original work product?Does the employee have controlling latitude of the final work product? Question No. 4: Do the employees primary duties consist of activities requiring invention, imagination, originality or talent in a recognized field of artistic or creative endeavor? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Computer Exemption Employee involved in design or application of computers and related systems Please read the following information provided to assist you in answering each of the questions at the end of the narratives. If questions 1 and 2 are answered yes the employee meets the computer exemption test. Question No. 1: Does the employee receive a salary of at least $455 per week or if paid hourly at a rate of not less than $17.63 per hour? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Question No. 2: Does the employees primary duty consist of the performance of work that requires the application of one of the following: YesNoSystems analysis techniques and procedures, including consulting with users to determine hardware, software, or system functional specifications FORMCHECKBOX  FORMCHECKBOX The design, development, documentation, analysis, creation, testing or modification of computer systems or programs, including prototypes, based on user or system design specifications? FORMCHECKBOX  FORMCHECKBOX The design, documentation, testing, creation, or modification of computer programs related to machine operating systems? FORMCHECKBOX  FORMCHECKBOX A combination of the duties stated above, which requires the same level of skill? FORMCHECKBOX  FORMCHECKBOX  The exemption typically requires the expertise and skill to work independently. The exemption does not apply to positions involving operation, repair or maintenance of computer hardware, networks or equipment.     PAGE  PAGE 9  FILENAME \p F:\ExemptNonExemptCklist.doc Salary The following applies to all exempt positions Salary means employee regularly receives a predetermined amount each pay period for work performed in any week. Salary is exclusive of board, lodging or other facilities. Employee may be subject to disciplinary deductions when applied to employee discipline Absences of a work day or longer may result in full-day salary reductions if the absence is caused by personal illness or other personal reasons Work week deductions are unavailable for absences caused by jury duty, witness duty, or temporary military leave. 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