Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Summers Drywall Services

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/28/2018 01:47 PM

Ruben Celia

Austin Jonas

On boom lift yet has no certs

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

03/01/2018

06/27/2018

8.00

11.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Trowel

Boom Lift

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

21.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature