Worker Interview - DSA

Worker Interview

General Information

Project Name: Dowling Middle School (Lawson) - HISD

Prime Contractor: Turner Construction Company

Subcontrctor: Cjs Yardworks

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/16/2018 02:03 PM

Jorge Rodriguez Cano

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

Yes

Job Classification

Union Member?

Apprentice?

Period

Landscape Laborer Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/01/2018

05/15/2018

8.00

10.00

Pay Type

Pay Day

deductions

OSHA

Cash

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Broom

Broom

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

2.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature