Worker Interview - DSA

Worker Interview

General Information

Project Name: Pilgrim Academy - HISD

Prime Contractor: DT Construction, LP

Subcontrctor: Belknap Plumbing Systems, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/14/2018 02:59 PM

Spencer Ames

Victor Bowen

None

ethnicity

gender

ssn

badge

White

Male

1873

No

Job Classification

Union Member?

Apprentice?

Period

Plumber Helper

No

No

4

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/15/2017

05/11/2017

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Power Tools

Hand Tools

Channel Locks

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

12.00

Backhoe

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature