Worker Interview - DSA

Worker Interview

General Information

Project Name: Askew Elementary School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: City Masonry Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/26/2017 12:00 AM

Roel Ruiz

Jorje Munoz

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer/Stone Mason

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/20/2017

09/25/2017

8.00

25.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Level

Trowel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature