Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Accurate Glass Systems of Texas, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/22/2018 10:26 AM

Gabriel Garcia

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/17/2018

05/21/2018

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Drills

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

16.00

Other Work?

Other Training?

Experience

Certifications

None

None

4.00

Boomlift, swing stage, forklift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature