Worker Interview - DSA

Worker Interview

General Information

Project Name: Jordan High School - HISD

Prime Contractor: Cadence McShane Construction

Subcontrctor: Telkin Sheetmetal Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/10/2018 11:04 AM

Efran ortiz

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Sheetmetal Worker-Ductwork

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/02/2018

05/09/2018

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Screw Gun

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

18.00

Non

Aware of Postings?

Threatened?

No Response

No

Signatures

Employee Signature

Auditor Signature