Worker Interview - DSA

Worker Interview

General Information

Project Name: Lamar High School - HISD

Prime Contractor: Gilbane Building Company

Subcontrctor: R2 Insulation, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/14/2017 12:00 AM

Ruben Comacho

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Insulator-Piping

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/01/2017

09/13/2017

8.00

21.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

Caulker

Channel Locks

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

O

0

18.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature