Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Lindo Mason

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/30/2018 02:53 PM

Julio alvarez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

0

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer/Stone Mason

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/16/2018

05/29/2018

10.00

28.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Drills

Power Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

25.00

Scaffold

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature