Worker Interview - DSA

Worker Interview

General Information

Project Name: Milby High School - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: Newcastle Masonry, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/10/2019 12:56 PM

Efren Avila

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

3251

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Light Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/01/2019

10/09/2019

8.00

20.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Hand Tools

Trowel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

30.00

Fork lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature