Worker Interview - DSA

Worker Interview

General Information

Project Name: Austin High School - HISD

Prime Contractor: Pepper-Lawson Construction

Subcontrctor: Meredith Environmental, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/20/2018 12:21 PM

J Refugio Gonzalez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Heavy Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2018

06/19/2018

9.00

21.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Knife

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

44.00

Other Work?

Other Training?

Experience

Certifications

None

None

32.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature