Worker Interview - DSA

Worker Interview

General Information

Project Name: Wilson Montessori School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: Sheffield Acoustical

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/17/2017 12:00 AM

Ruben Yepez

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Ceiling Tile Installer

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/17/2017

10/17/2017

8.00

18.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Drills

Tape Measure

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

0

0

10.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature