Worker Interview - DSA

Worker Interview

General Information

Project Name: Austin High School - HISD

Prime Contractor: Pepper-Lawson Construction

Subcontrctor: Meredith Environmental, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/21/2018 12:33 PM

Jose Arellano

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

9307

No

Job Classification

Union Member?

Apprentice?

Period

Asbestos Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/01/2018

05/18/2018

9.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Knife

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

45.00

Other Work?

Other Training?

Experience

Certifications

None

None

14.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature