Tip Pooling Violation Complaint

TIP POOLING VIOLATION COMPLAINT

COMPLAINT FOR UNLAWFUL TIP PRACTICES UNDER THE FAIR LABOR STANDARDS ACT

PART 1: COMPLAINANT INFORMATION

Full Legal Name: _______________________________________________

Current Address:

• Street: _______________________________________________
• City: _________________________ State: _____ ZIP: ___________

Contact Information:

• Phone: _________________________
• Email: _________________________
• Preferred Contact Method: ☐ Phone ☐ Email ☐ Mail

PART 2: EMPLOYER INFORMATION

Employer/Restaurant Name: _______________________________________________

Doing Business As (DBA): _______________________________________________

Employer Address:

• Street: _______________________________________________
• City: _________________________ State: _____ ZIP: ___________

Employer Phone: _________________________

Type of Establishment:
☐ Full-service restaurant
☐ Fast food/quick service
☐ Bar/nightclub
☐ Hotel/resort
☐ Casino
☐ Catering
☐ Coffee shop/cafe
☐ Other: _________________________

Owner/Manager Name(s):

1. _______________________________________________
2. _______________________________________________

Number of Employees (estimate): _________________________

PART 3: EMPLOYMENT INFORMATION

Job Title: _______________________________________________

Type of Tipped Position:
☐ Server/Waiter/Waitress
☐ Bartender
☐ Host/Hostess
☐ Busser/Busboy
☐ Barback
☐ Food Runner
☐ Delivery Driver
☐ Valet
☐ Other: _________________________

Date of Hire: _________________________

Date Employment Ended (if applicable): _________________________

Current Employment Status:
☐ Currently Employed
☐ Terminated
☐ Resigned
☐ Laid Off

PART 4: WAGE AND TIP INFORMATION

Cash Wage Paid by Employer: $__________ per hour

Does Employer Claim Tip Credit?
☐ Yes ☐ No ☐ Unknown

Applicable Minimum Wage:

• Federal Minimum Wage: $7.25/hour
• State Minimum Wage: $__________/hour
• Local Minimum Wage (if higher): $__________/hour

Federal Minimum Cash Wage for Tipped Employees: $2.13/hour (if tip credit claimed)

State Minimum Cash Wage for Tipped Employees: $__________/hour

Average Tips Received:

• Per hour: $__________
• Per shift: $__________
• Per week: $__________

How Were Tips Received?
☐ Cash tips directly from customers
☐ Credit card tips
☐ Both cash and credit card
☐ Service charges
☐ Other: _________________________

PART 5: TIP POOL ARRANGEMENT

Does Your Employer Have a Tip Pool?
☐ Yes ☐ No

If No, skip to Part 6

Tip Pool Details:

Who is INCLUDED in the tip pool? (check all that apply)
☐ Servers
☐ Bartenders
☐ Bussers
☐ Food runners
☐ Hosts/hostesses
☐ Barbacks
☐ Cooks/kitchen staff
☐ Dishwashers
☐ Managers/supervisors
☐ Owners
☐ Other: _________________________

Tip Pool Percentage Distribution:

How is the Tip Pool Calculated?
☐ Percentage of total sales
☐ Percentage of tips received
☐ Fixed dollar amount per shift
☐ Points system
☐ Other: _________________________

PART 6: TYPE OF TIP VIOLATION (Check All That Apply)

Employer/Management Taking Tips

☐ Owner retains portion of employee tips
☐ Manager/supervisor takes tips from pool
☐ Management participates in tip pool
☐ Employer deducts credit card processing fees from tips
☐ Employer uses tips to pay for business expenses
☐ Employer uses tips to pay other employees' wages
☐ Employer redistributes tips unfairly

Illegal Tip Pool Participants (While Employer Claims Tip Credit)

☐ Back-of-house employees (cooks, dishwashers) included in tip pool
☐ Non-customer-facing employees included
☐ Janitors/maintenance included
☐ Security personnel included
☐ Other non-tipped employees included: _________________________

Tip Credit Violations

☐ Employer did not inform me of tip credit provisions BEFORE taking credit
☐ Combined cash wage + tips did not equal minimum wage
☐ Employer claimed tip credit while I performed non-tipped duties
☐ No "tip credit notice" provided at time of hire

80/20 Rule Violations (Dual Jobs/Side Work)

☐ Spent more than 20% of shift on non-tipped duties
☐ Performed non-tipped work for more than 30 consecutive minutes
☐ Tip credit applied during extensive side work

Types of Non-Tipped Duties Performed:
☐ Cleaning (non-incidental)
☐ Food prep
☐ Dishwashing
☐ Stocking
☐ Maintenance
☐ Administrative tasks
☐ Other: _________________________

Estimated Time Spent on Non-Tipped Duties: _____% of shift

Other Tip Violations

☐ Mandatory tip-out to non-eligible employees
☐ Tips not distributed in timely manner
☐ Tips withheld as discipline
☐ Tips withheld for walkouts/dine-and-dash
☐ Tips withheld for cash register shortages
☐ Forced to pay for breakage out of tips
☐ Other: _________________________

PART 7: DETAILED DESCRIPTION OF VIOLATION

Describe in detail what happened with your tips:
(Include specific incidents, dates, amounts, and who was involved)

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

How did you learn about the tip practices?
_______________________________________________
_______________________________________________

PART 8: TIP CREDIT NOTICE REQUIREMENTS

Did your employer provide written notice of the following BEFORE taking a tip credit?

☐ The amount of cash wage the employer is paying
☐ The additional amount claimed as a tip credit (cannot exceed tips received)
☐ That the tip credit cannot exceed the amount of tips received
☐ That all tips received must be retained by the employee (except valid tip pool)
☐ That the tip credit will not apply unless informed of these provisions

When was this notice provided (if at all)?
☐ At hire, in writing
☐ At hire, verbally
☐ After employment began
☐ Never provided

PART 9: CALCULATION OF TIP LOSSES

Period of Violation:

• Start Date: _________________________
• End Date: _________________________ ☐ Ongoing

Calculation of Tips Unlawfully Taken/Withheld:

Method 1: Management/Owner Taking Tips

Subtotal Tips Taken by Management: $_________________________

Method 2: Illegal Tip Pool Distribution

Subtotal Illegal Tip Pool Distributions: $_________________________

Method 3: Tip Credit Violation (Minimum Wage Shortfall)

Subtotal Minimum Wage Shortfall: $_________________________

Method 4: Credit Card Fee Deductions

Subtotal Credit Card Fee Deductions: $_________________________

TOTAL DAMAGES CALCULATION

PART 10: SUPPORTING DOCUMENTATION

Documents Available (check all that apply):

☐ Pay stubs showing tip amounts
☐ Tip pool records/tip-out sheets
☐ Credit card receipts showing tips
☐ Cash tip records
☐ Work schedules
☐ Employee handbook/tip policy
☐ Wage notice provided at hire
☐ Text messages/emails about tips
☐ Photographs of tip policies/signs
☐ Personal tip log
☐ Witness statements
☐ Other: _________________________

PART 11: WITNESSES

Are there witnesses who can confirm the tip violations?
☐ Yes ☐ No

Witness Information:

Witness 1:

• Name: _______________________________________________
• Position: _________________________
• Phone: _________________________
• What can they confirm? _______________________________________________

Witness 2:

• Name: _______________________________________________
• Position: _________________________
• Phone: _________________________
• What can they confirm? _______________________________________________

Witness 3:

• Name: _______________________________________________
• Position: _________________________
• Phone: _________________________
• What can they confirm? _______________________________________________

PART 12: OTHER AFFECTED EMPLOYEES

Are other employees affected by these tip violations?
☐ Yes ☐ No ☐ Unknown

If yes:

• Estimated number of affected employees: _________________________
• Job titles: _______________________________________________
• Would they participate in a complaint? ☐ Yes ☐ No ☐ Unknown

PART 13: PRIOR COMPLAINTS AND RETALIATION

Have you complained to your employer about tip practices?
☐ Yes ☐ No

If yes:

• Date: _________________________
• To whom: _________________________
• Response: _______________________________________________

Have you experienced retaliation?
☐ Yes ☐ No

If yes, describe:
☐ Termination
☐ Reduced hours
☐ Unfavorable schedule
☐ Reduced tip pool share
☐ Hostile treatment
☐ Demotion
☐ Other: _________________________

PART 14: STATE-SPECIFIC NOTES

CALIFORNIA

• No tip credit allowed - Employers must pay full state minimum wage regardless of tips
• Tips belong 100% to employees under Labor Code § 351
• Employers cannot collect, take, or receive any gratuity
• Managers and supervisors cannot share in tips
• Valid tip pooling limited to employees providing direct service
• File with DLSE Labor Commissioner

TEXAS

• Texas follows federal FLSA tip credit rules
• Minimum cash wage: $2.13/hour with tip credit
• Tips must bring total to at least $7.25/hour
• File with U.S. DOL Wage and Hour Division

FLORIDA

• Florida allows tip credit
• Minimum cash wage for tipped employees: $10.98/hour (2026)
• Tips must bring total to state minimum wage ($14.00/hour in 2026)
• File with U.S. DOL (no state enforcement)

NEW YORK

• Tip credit allowed but varies by industry and region
• Hospitality Industry Wage Order provides specific tip rules
• Tip threshold for tip credit: Must receive more than $30/month in tips
• File with NY Department of Labor

PART 15: FILING OPTIONS

I intend to file this complaint with:

☐ U.S. Department of Labor, Wage and Hour Division

• Phone: 1-866-4-US-WAGE (1-866-487-9243)
• Website: www.dol.gov/agencies/whd/contact/complaints
• Penalty: Up to $1,162 per violation plus back pay

☐ State Labor Agency

• State: _________________________
• Agency: _________________________

☐ Private Attorney/Lawsuit

• May recover tips, liquidated damages, attorney fees

PART 16: PENALTIES AVAILABLE

Federal Penalties (FLSA):

• Recovery of unlawfully kept tips
• Liquidated damages equal to tips taken
• Civil money penalties up to $1,162 per violation
• Attorney's fees and costs

Criminal Penalties:

• Willful violations may result in criminal prosecution
• Fine up to $10,000 and/or imprisonment

PART 17: DECLARATION

I declare under penalty of perjury that the information in this complaint is true and correct to the best of my knowledge. I understand that providing false information may subject me to penalties.

I authorize investigation of this complaint and contact with my employer.

Complainant Signature: _______________________________________________

Printed Name: _______________________________________________

Date: _________________________

PART 18: ATTORNEY INFORMATION (IF REPRESENTED)

Attorney Name: _______________________________________________

Law Firm: _______________________________________________

Address: _______________________________________________

Phone: _________________________ Email: _________________________

Bar Number: _________________________

CHECKLIST BEFORE FILING

☐ All sections completed
☐ Type of tip violation identified
☐ Tip losses calculated
☐ Supporting documents gathered
☐ Witnesses identified
☐ Copies made for records
☐ State-specific rules reviewed
☐ Statute of limitations verified (2 years, or 3 if willful)

RESOURCES

• DOL Tip Regulations: www.dol.gov/agencies/whd/flsa/tips
• DOL Tip FAQ: www.dol.gov/agencies/whd/flsa/tipsFAQ
• Fact Sheet #15: www.dol.gov/agencies/whd/fact-sheets/15-tipped-employees-flsa
• Worker.gov: www.worker.gov

This template is provided for informational purposes only and does not constitute legal advice. Tip laws are complex and vary by federal, state, and local jurisdiction. Consult with a qualified employment attorney for advice specific to your situation.