Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: JDR Installations

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/21/2018 11:29 AM

Rodolfo alvarez

Austin Jonas

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/21/2018

08/21/2018

8.00

22.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Power Tools

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

Blueprints, forklift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature