Worker Interview - DSA

Worker Interview

General Information

Project Name: Milby High School - HISD

Prime Contractor: Tellepsen Builders, LP

Subcontrctor: SLS Landscape

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/27/2017 12:00 AM

Venancio Acabal

Yolanda Gaines

Pay bi-weekly

ethnicity

gender

ssn

badge

Hispanic

Male

1234

Yes

Job Classification

Union Member?

Apprentice?

Period

Landscape Laborer Skilled

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/27/2017

06/26/2017

11.00

13.00

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Shovel

Backhoe

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

10.00

Other Work?

Other Training?

Experience

Certifications

11.00

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature