Worker Interview - DSA

Worker Interview

General Information

Project Name: Wharton K-8 Dual Language Academy - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: LMI Painting LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/04/2018 02:13 PM

Oscar medina

Victor Bowen

Na

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2018

05/31/2018

10.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Paint brush

Clamps

Broom

Measuring tape

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

15.00

Other Work?

Other Training?

Experience

Certifications

Na

No

0.00

No

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature