Worker Interview - DSA

Worker Interview

General Information

Project Name: Wilson Montessori School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: Koetter Fire Protection of Houston LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/18/2017 12:00 AM

Blane Martinez

Yolanda Gaines

None

ethnicity

gender

ssn

badge

White

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Electronic Data

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/10/2017

07/17/2017

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Power Tools

Hand Tools

Drills

Gloves

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

Safety daily

4.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature