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 02:22 PM

Samuel Galvan

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1848

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/25/2019

10/16/2019

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Clamps

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

40.00

Boom scissor fork fall

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature