Worker Interview - DSA

Worker Interview

General Information

Project Name: Wilson Montessori School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: Ultra Air Systems

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/24/2018 09:59 AM

Antonio Gonzalez

Lionel Blackwell

Gets paid in cash

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

HVAC Installer/Mechanic

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/01/2018

07/19/2018

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Cash

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Drills

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

16.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature