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 12:59 PM

Lucio Gaitan

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Landscape Laborer-Semi Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/18/2019

10/09/2019

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Hand Tools

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

15.00

none

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature