Worker Interview - DSA

Worker Interview

General Information

Project Name: Garden Oaks Montessori - HISD

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

Subcontrctor: Camarata Masonry

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/18/2017 12:00 AM

Horace Sullivan

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Black

Male

1652

Yes

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/28/2017

10/17/2017

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Trowel

Shovel

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

Mixer

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature