Worker Interview - DSA

Worker Interview

General Information

Project Name: Dowling Middle School (Lawson) - HISD

Prime Contractor: Turner Construction Company

Subcontrctor: Cjs Yardworks

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/30/2019 12:18 PM

Jose Sandoval gomez

Victor Bowen

PW issue

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Heavy Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/05/2018

01/29/2019

10.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Wednesday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tractors

Shovel

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

50.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature