Worker Interview - DSA

Worker Interview

General Information

Project Name: Austin High School - HISD

Prime Contractor: Pepper-Lawson Construction

Subcontrctor: Momentum Exterior Systems, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/17/2019 02:24 PM

Ismael Quintanilla

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

8630

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/14/2019

10/16/2019

8.00

23.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

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

8.00

Scissor lift boom lift

Aware of Postings?

Threatened?

Yes

Yes

Signatures

Employee Signature

Auditor Signature