Worker Interview - DSA

Worker Interview

General Information

Project Name: HSLECJ - HISD

Prime Contractor: B3Ci (JV BETWEEN BALFOUR BEATTY & 3Ci CONSTRUCTION)

Subcontrctor: Karsten Interior Services, LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/21/2017 12:00 AM

Ernesto Pena

Yolanda Gaines

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

Yes

Job Classification

Union Member?

Apprentice?

Period

Drywall Hanger

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2017

08/19/2007

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Boom Lift

Hand Tools

Drills

Hard hat

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

Safety daily

15.00

Boom lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature