Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Overhead doors

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/10/2018 11:20 AM

Louis Delarosa

Lionel Blackwell

Paid bi weekly

ethnicity

gender

ssn

badge

Hispanic

Male

3255

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/01/2017

07/09/2018

6.50

27.58

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Drills

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

31.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature