Tip Pooling Policy + Tip Credit Notice

TIP POOLING POLICY AND TIP CREDIT NOTICE Establishment name​ — effective Policy effective date

PART A — TIP POOLING POLICY

1. PARTICIPATION 1.1. The tip pool includes the following roles: Tip pool participants​. 1.2. Distribution formula: Distribution formula​. 1.3. Pooled tips are distributed with each paycheck (Pay frequencyWeeklyBi-weeklySemi-monthly) and are reported as wages on the employee's pay statement.

2. PROHIBITION ON MANAGER AND OWNER PARTICIPATION 2.1. Under the federal Fair Labor Standards Act, § 3(m), managers, supervisors, and owners may never keep any portion of employee tips or participate in a tip pool, even if they perform some tipped duties. Violations may result in repayment of tips plus liquidated damages and civil money penalties. 2.2. Where a tip credit is NOT taken, the tip pool may include back-of-house employees (e.g. cooks, dishwashers). Where a tip credit IS taken, the pool is limited to employees who customarily and regularly receive tips.

PART B — TIP CREDIT NOTICE (FLSA § 3(m)(2)(A))

3. NOTICE 3.1. Tip credit taken by employer: Tip credit taken?Yes — employer takes a tip creditNo — employees are paid full minimum wage plus tips. 3.2. If a tip credit is taken: the cash wage paid directly by Establishment name​ is Cash wage paid to tipped employees​ per hour; the additional amount claimed as a tip credit toward minimum wage is Tip credit amount claimed​ per hour. The tip credit claimed may not exceed the amount of tips actually received. 3.3. All tips received by an employee are the property of that employee, except for a valid tip pool described above. The employee has the right to retain all tips received, subject only to that valid pooling arrangement. 3.4. This notice must be provided before a tip credit is taken; providing it orally is legally sufficient but a signed written notice is the only reliably provable form in a wage dispute. 3.5. ⚠️ Minimum cash wage and tip-credit eligibility vary significantly by state; several states (including California, Washington, Oregon, Minnesota, Montana, Alaska, and Nevada) do not permit a tip credit at all. Verify current requirements for the Establishment name​ state before relying on this notice.

ACKNOWLEDGMENT I, Employee name (for notice acknowledgment)​, acknowledge that I have received and understand this Tip Pooling Policy and Tip Credit Notice.

Employee signature ______________ / Employee name (for notice acknowledgment)​ / Date: Acknowledgment date