Worker Interview - DSA

Worker Interview

General Information

Project Name: HSPVA - HISD

Prime Contractor: McCarthy Building Company

Subcontrctor: Ford Audio - Video Systems, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/04/2018 10:01 AM

Caleb Sherraden

Jorje Munoz

None

ethnicity

gender

ssn

badge

White

Male

9456

No

Job Classification

Union Member?

Apprentice?

Period

Electronic Data

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/24/2018

05/03/2018

9.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Grinder

Screw Gun

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

None

None

0.00

Scissor lift and boomlift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature