Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: MH Brothers, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/24/2017 12:00 AM

Christian Reyna

Yolanda Gaines

0

ethnicity

gender

ssn

badge

Hispanic

Male

1999

Yes

Job Classification

Union Member?

Apprentice?

Period

Roofer

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/21/2017

08/24/2017

11.00

13.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

Hammer

Drills

Hard hat

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

Safety daily

1.00

None

Aware of Postings?

Threatened?

Yes

No Response

Signatures

Employee Signature

Auditor Signature