Worker Interview - DSA

Worker Interview

General Information

Project Name: Bellaire High School - HISD

Prime Contractor: Turner Construction Company

Subcontrctor: Duty Construction, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/02/2018 03:20 PM

Telesforo R. Medina

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

Yes

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/01/2018

06/30/2018

7.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Hand Tools

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

45.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature