Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: L. V. Industries Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/28/2017 12:00 AM

Jeremy Mouton

Jorje Munoz

0

ethnicity

gender

ssn

badge

Black

Male

1856

No

Job Classification

Union Member?

Apprentice?

Period

HVAC Installer/Mechanic

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/01/2016

09/26/2017

10.00

17.12

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Screwdriver

Cutters

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

20.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Forklift, scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature