Worker Interview - DSA

Worker Interview

General Information

Project Name: Askew Elementary School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: ABC Janitorial

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/01/2018 10:49 AM

Matt chevalier

Victor Bowen

None

ethnicity

gender

ssn

badge

Black

Male

5172

No

Job Classification

Union Member?

Apprentice?

Period

Landscape Laborer Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/24/2018

10/31/2018

4.00

11.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Hand Tools

Broom

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

2.00

Scaffold

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature