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

Rethought Mendoza

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

3751

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/01/2017

07/05/2017

10.00

16.25

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Level

Channel Locks

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature