Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: R&E Painting

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/22/2017 12:00 AM

Javier Inestroza

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

8229

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/01/2017

09/21/2017

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Roller

Staple Gun

Paint brush

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

None

None

13.00

Boomlift, scissor lift, scaffold

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature