Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Belknap Plumbing Systems, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/22/2017 12:00 AM

Mitchell Hughlett

Lionel Blackwell

0

ethnicity

gender

ssn

badge

White

Male

4270

No

Job Classification

Union Member?

Apprentice?

Period

Plumber Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2017

09/21/2017

8.00

14.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Caulker

Channel Locks

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

38.00

Other Work?

Other Training?

Experience

Certifications

0

0

5.00

0

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature