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

Manuel Martinez

Victor Bowen

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer Helper

No Response

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/22/2017

09/25/2017

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Hand Tools

Knife

No

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

8.00

Other Work?

Other Training?

Experience

Certifications

0

0

3.00

0

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature