Worker Interview - DSA

Worker Interview

General Information

Project Name: Austin High School - HISD

Prime Contractor: Pepper-Lawson Construction

Subcontrctor: Diversified Thermal, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/03/2019 02:54 PM

Ryan Roebuck

Lionel Blackwell

None

ethnicity

gender

ssn

badge

White

Male

=CHAR(048)&169

No

Job Classification

Union Member?

Apprentice?

Period

Insulator-Building

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/20/2010

10/02/2019

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

Tape Measure

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Scissor boom lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature