Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Tejas Electrical Services, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/06/2017 12:00 AM

Royal boncamp

Victor Bowen

ethnicity

gender

ssn

badge

Black

Male

=CHAR(048)&304

Yes

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/06/2017

07/05/2017

10.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Power Tools

Drills

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

48.00

Other Work?

Other Training?

Experience

Certifications

No

None

4.00

No

Aware of Postings?

Threatened?

Yes

Yes

Signatures

Employee Signature

Auditor Signature