Worker Interview - DSA

Worker Interview

General Information

Project Name: Parker Elementary School - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: CAI Services

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/05/2017 12:00 AM

JoseL.Hernandez

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

8150

No

Job Classification

Union Member?

Apprentice?

Period

HVAC Installer/Mechanic

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/01/2017

10/04/2017

8.00

25.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Level

Channel Locks

Tape Measure

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

0

0

4.00

0

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature