Worker Interview - DSA

Worker Interview

General Information

Project Name: Wharton K-8 Dual Language Academy - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: Jim Hoffman Tile, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/31/2018 09:39 AM

Omar Gonzalez

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

=CHAR(048)&354

No

Job Classification

Union Member?

Apprentice?

Period

Tile Setter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/09/2018

07/27/2018

8.00

20.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Channel Locks

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

8.00

Other Work?

Other Training?

Experience

Certifications

None

None

12.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature