Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: MAA Mechanical Services

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/21/2017 12:00 AM

Cory Green

Victor Bowen

0

ethnicity

gender

ssn

badge

Black

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

HVAC Trainee/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/24/2017

09/20/2017

10.00

10.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Saw Saw

Drills

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

0

0

12.00

No

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature