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 02:54 PM

Rene Rivas

Austin Jonas

No

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Semi Skilled/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/21/2018

05/29/2018

9.00

14.00

Pay Type

Pay Day

deductions

OSHA

Cash

Saturday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Ladder

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

27.00

Other Work?

Other Training?

Experience

Certifications

No

No

1.00

No

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature