Worker Interview - DSA

Worker Interview

General Information

Project Name: Milby High School - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: EDH Plumbing Contractors

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/17/2019 01:16 PM

Mark Mendoza

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

2972

Yes

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/15/2019

10/16/2019

8.00

13.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Drills

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 lift fork lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature