Worker Interview - DSA

Worker Interview

General Information

Project Name: Garden Oaks Montessori - HISD

Prime Contractor: B3Ci (JV BETWEEN BALFOUR BEATTY & 3Ci CONSTRUCTION)

Subcontrctor: CLS Technology, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/28/2017 12:00 AM

Josh Zapata

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

6343

No

Job Classification

Union Member?

Apprentice?

Period

Electronic Data

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/01/2017

09/27/2017

8.00

14.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Wednesday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Drills

Saw Saw

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

26.00

Other Work?

Other Training?

Experience

Certifications

0

0

3.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature