Worker Interview - DSA

Worker Interview

General Information

Project Name: Milby High School - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: Pacesetter Personnel Services

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/25/2019 01:12 PM

Nico Randall

Lionel Blackwell

Pwi

ethnicity

gender

ssn

badge

Black

Male

5955

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Unskilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/25/2019

07/25/2019

8.00

7.25

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Broom

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature