Worker Interview - DSA

Worker Interview

General Information

Project Name: Lamar High School - HISD

Prime Contractor: Gilbane Building Company

Subcontrctor: CMC Ultd.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/12/2018 10:31 AM

Julio Moreno

Austin Jonas

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Trim & Finish

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/12/2018

06/12/2018

0.00

19.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Hand Tools

Scaffold

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

18.00

Scaffold, mast climber, and swing state building

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature