Worker Interview - DSA

Worker Interview

General Information

Project Name: Wilson Montessori School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: Summers Drywall Services

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/01/2018 01:36 PM

Alejandro medina

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Drywall Hanger

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/29/2018

04/30/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Channel Locks

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

8.00

Scissor boom

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature