Worker Interview - DSA

Worker Interview

General Information

Project Name: Sharpstown High School - HISD

Prime Contractor: ICI Construction

Subcontrctor: Texas Premier Drywall Systems, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/11/2017 12:00 AM

Alejandro Tambriz

Victor Bowen

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Drywall Hanger

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/05/2017

07/10/2017

12.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hand Tools

Hammer

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

36.00

Other Work?

Other Training?

Experience

Certifications

None

None

13.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature