Worker Interview - DSA

Worker Interview

General Information

Project Name: Lamar High School - HISD

Prime Contractor: Gilbane Building Company

Subcontrctor: Winco Masonry

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/27/2018 02:32 PM

Jose Gordova

Austin Jonas

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Heavy Equip

No

Yes

7

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/20/2018

06/26/2018

8.00

24.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Boom Lift

Scissor Lift

Forklift

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

8.00

Other Work?

Other Training?

Experience

Certifications

None

None

15.00

Boom lift, scissor lift, etc

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature