Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Manbro Contracting LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/06/2018 09:30 AM

Rene Manila

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

02/01/2018

06/05/2018

8.00

20.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Tuesday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Tape Measure

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

36.00

Other Work?

Other Training?

Experience

Certifications

None

None

40.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature