Worker Interview - DSA

Worker Interview

General Information

Project Name: HSPVA - HISD

Prime Contractor: McCarthy Building Company

Subcontrctor: Max Grigsby Co. Inc. dba MGC Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/18/2018 10:51 AM

Roeuthany Klam

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

3013

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

02/10/2018

02/17/2018

8.00

28.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hand Tools

Power Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

Yes

Yes

56.00

Other Work?

Other Training?

Experience

Certifications

None

None

11.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature