Worker Interview - DSA

Worker Interview

General Information

Project Name: Parker Elementary School - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: City Masonry Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/16/2017 12:00 AM

Nelson mejia

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer/Stone Mason

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/10/2017

08/15/2017

8.00

25.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Scraper

Trowel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

17.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature