Worker Interview - DSA

Worker Interview

General Information

Project Name: Sharpstown High School - HISD

Prime Contractor: ICI Construction

Subcontrctor: Chief Fire Systems, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/11/2017 12:00 AM

Erick peralez

Lionel Blackwell

O

ethnicity

gender

ssn

badge

Hispanic

Male

7528

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/11/2017

07/10/2017

10.00

13.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Wrench

Tape Measure

O

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

O

O

3.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature