Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Steelco, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/15/2018 11:28 AM

David Suria Guzman

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Welder-Pipe

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/01/2018

05/14/2002

8.00

21.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Welding torch

Welding machine

Drills

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 lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature