Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Southern Tile & Terrazzo Co.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/28/2017 12:00 AM

Arturo Rivera

Jorje Munoz

0

ethnicity

gender

ssn

badge

Hispanic

Male

2434

No

Job Classification

Union Member?

Apprentice?

Period

Tile Setter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/25/2017

09/27/2017

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

Grinder

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

Respiratory mask

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature