Worker Interview - DSA

Worker Interview

General Information

Project Name: Jordan High School - HISD

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

Subcontrctor: Pinnacle Tile & Flooring, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/08/2018 11:46 AM

Leo orozco

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Floor Layer/Finisher

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/01/2018

11/07/2018

9.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Knife

Scraper

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

48.00

Other Work?

Other Training?

Experience

Certifications

None

None

16.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature