Worker Interview - DSA

Worker Interview

General Information

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

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: Littlefield Brothers Concrete Construction, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/21/2017 12:00 AM

Gersain yañez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

Yes

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/20/2017

08/18/2017

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Hand Tools

Knife

Done

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

46.00

Other Work?

Other Training?

Experience

Certifications

No

None

1.00

No

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature