Worker Interview - DSA

Worker Interview

General Information

Project Name: HSLECJ - HISD

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

Subcontrctor: Karsten Interior Services, LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/16/2017 12:00 AM

David Palacios

Jorje Munoz

0

ethnicity

gender

ssn

badge

Hispanic

Male

4696

No

Job Classification

Union Member?

Apprentice?

Period

Drywall Hanger

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/12/2017

10/13/2017

8.00

14.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Ladder

Drills

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

16.00

Other Work?

Other Training?

Experience

Certifications

None

None

4.00

Scissor lift, scaffold

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature