Worker Interview - DSA

Worker Interview

General Information

Project Name: Wharton K-8 Dual Language Academy - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: K & S Contracting, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/13/2017 12:00 AM

Juan Gallegos

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

HVAC Trainee/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/01/2017

10/12/2017

8.00

14.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Channel Locks

Drills

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

0

0

3.00

0

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature