Worker Interview - DSA

Worker Interview

General Information

Project Name: Austin High School - HISD

Prime Contractor: Pepper-Lawson Construction

Subcontrctor: Meredith Environmental, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/19/2019 11:34 AM

Sergio Pena Jr.

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

5575

No

Job Classification

Union Member?

Apprentice?

Period

Asbestos Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/01/2019

11/18/2019

9.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Broom

Saw Saw

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

45.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature