Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Yellowstone Landscaping

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/15/2018 11:16 AM

Ruben Chavez

Austin Jonas

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Landscape Laborer Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2018

05/14/2018

8.00

12.94

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Hand Tools

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

Yes

No

40.00

Other Work?

Other Training?

Experience

Certifications

No

None

3.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature