Worker Interview - DSA

Worker Interview

General Information

Project Name: Wilson Montessori School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: City Masonry Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/13/2017 12:00 AM

Roberto Hernandez

Lionel Blackwell

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2017

07/12/2017

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Tape Measure

Wrench

Level

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

Wash down

0

2.00

0

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature