Worker Interview - DSA

Worker Interview

General Information

Project Name: HSLECJ - HISD

Prime Contractor: B3Ci (JV BETWEEN BALFOUR BEATTY & 3Ci CONSTRUCTION)

Subcontrctor: Gulf Star Roofing and Sheetmetal

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/15/2017 12:00 AM

Saul Juarez

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Sheetmetal Worker-Roofing

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/13/2017

09/14/2017

9.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Snips

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

7.00

Boomlift and scissor lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature