Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Littlefield Brothers Concrete Construction, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/28/2017 12:00 AM

Rafael Lopez

Lionel Blackwell

O

ethnicity

gender

ssn

badge

Hispanic

Male

2228

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/26/2017

06/26/2017

8.00

14.25

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Level

Saw Saw

Tape Measure

Drill

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

O

O

20.00

O

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature