Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Southern Tile & Terrazzo Co.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/21/2017 12:00 AM

Marcelo Campos

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/15/2017

09/20/2017

8.00

15.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Spatula

Knife

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

7.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature