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

12/14/2018 11:07 AM

David Cruz

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

12/07/2018

12/13/2018

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Ladder

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

9.00

Scissor and boomlift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature