Worker Interview - DSA

Worker Interview

General Information

Project Name: HSPVA - HISD

Prime Contractor: McCarthy Building Company

Subcontrctor: Ruppert

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/23/2018 09:11 AM

Ramon Loyola

Austin Jonas

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Landscape Laborer Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/23/2018

07/20/2018

10.00

20.00

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Shovel

Saw Saw

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

50.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

Heavy equipment

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature