EMPLOYEE/CONTRACTOR QUESTIONNAIRE

EMPLOYER/PRINCIPALS VERSION

1)

Were the hours of work controlled or could the person have worked whatever hours
he/she wished? (Please attach a list of the hours worked each day.)
________________________________________________________________________
________________________________________________________________________

2)

How often was the persons work inspected? Daily? Weekly? More often?
________________________________________________________________________

3)

Who inspected the persons work?

Name: __________________________________________________________________
Position: ________________________________________________________________
Company: _______________________________________________________________

4)

Did the person in question supervise any employees of your business or enterprise?
Yes

5)

Was the person in question required to submit time sheets?

Yes

6)

No

Was the persons time recorded on his/her behalf by the employer/principal?

Yes

7)

No

No

Did your business supply tools and equipment for use by the person in question?
Yes

No

If so, what equipment did you supply?

________________________________________________________________________
________________________________________________________________________

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8)

Did the person in question supply tools or equipment?

Yes

No

If so, what tools and equipment were supplied free of charge?

________________________________________________________________________
________________________________________________________________________
If so, what tools and equipment were rented to your business?
________________________________________________________________________
________________________________________________________________________

9)

If the person had completed his/her work more quickly than scheduled would he/she have
been paid the same amount as if it had taken the scheduled length of time?
Yes

10)

No

If the person had completed his/her work more slowly than scheduled would he/she only
have been entitled to receive the same amount as if the work had been completed on
schedule?
Yes

11)

No

Could the person have taken other employment at the same time as he/she was working
for your business or enterprise, assuming that such work was available?
Yes

12)

No

Were deductions taken from the payments made to the person in question for:
Income Tax:

Yes

No

Canada Pension Plan:

Yes

No

Unemployment Insurance:

Yes

No

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13)

Was Workers Compensation coverage provided for the person in question on behalf of
your business or enterprise?
Yes

14)

No

Could the person have employed other workers, to be paid by himself or herself, to help
with the work?

Did he/she do so?

Yes

No

Yes

No

If so, who was employed?

________________________________________________________________________
________________________________________________________________________

15)

Could the person have provided a replacement for himself or herself without your express
permission?
Yes

16)

No

To the best of your knowledge, does the person operate a business performing the sort of
work done for you?
Yes

No

If so, is that business a corporation?

Yes

No

If so, what is the name of the business?

________________________________________________________________________

17)

Did the person tender an amount for the job?

Yes

No

Yes

No

Did you specify the pay rate?

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18)

Could you have unilaterally terminated the work relationship with the individual in
question?
Yes

No

COMPLETED BY: _________________________________________________

Name (Please Print)
_________________________________________________
Signature
_________________________________________________
Company
_________________________________________________
Date
PERTAINING TO: _________________________________________________
Name of Employee/Contractor (Please Print)

PLEASE RETURN COMPLETED QUESTIONNAIRE TO:

LABOUR SERVICES
DEPARTMENT OF JUSTICE
GOVERNMENT OF THE NORTHWEST TERRITORIES
PO BOX 1320
YELLOWKNIFE, NT X1A 2L9

Fax #: (867) 873-0483

Phone #: (867) 873-7486

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