Worker Interview - DSA

Worker Interview

General Information

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

Prime Contractor: Prime Contractors Inc

Subcontrctor: Bauer Sport Floor

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/25/2018 09:38 AM

Jose lara

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Floor Layer/Finisher

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/23/2018

07/24/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Spatula

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

4.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature