Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: TX Lonestar Mechanical

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/16/2018 10:27 AM

Abram Gallegos

Austin Jonas

None

ethnicity

gender

ssn

badge

Hispanic

Male

3216

No

Job Classification

Union Member?

Apprentice?

Period

HVAC Trainee/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/01/2018

05/15/2018

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Wrench

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

No

3.00

HVAC Cert

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature