Worker Interview - DSA

Worker Interview

General Information

Project Name: Jordan High School - HISD

Prime Contractor: Cadence McShane Construction

Subcontrctor: LMI Painting LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/08/2018 01:15 PM

Norman vargas

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

6455

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/14/2018

10/05/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Roller

Paint brush

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

Boom scissor

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature