Worker Interview - DSA

Worker Interview

General Information

Project Name: Lamar High School - HISD

Prime Contractor: Gilbane Building Company

Subcontrctor: Momentum Glass

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/27/2019 10:37 AM

Fernando Perez Dominguez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No Response

Job Classification

Union Member?

Apprentice?

Period

Glaziers

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/25/2019

06/25/2019

0.00

0.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Channel Locks

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

2.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature