Worker Interview - DSA

Worker Interview

General Information

Project Name: Jordan High School - HISD

Prime Contractor: Cadence McShane Construction

Subcontrctor: Pinnacle Tile & Flooring, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/19/2018 10:21 AM

Gary Reynolds

Lionel Blackwell

None

ethnicity

gender

ssn

badge

White

Male

6169

No

Job Classification

Union Member?

Apprentice?

Period

Tile Setter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/01/2018

07/18/2028

2.00

31.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

Level

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

14.00

Other Work?

Other Training?

Experience

Certifications

None

None

40.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature