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

07/19/2017 12:00 AM

Erick Espinoza

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Drywall Hanger

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/20/2017

07/18/2017

8.00

14.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Monday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

Boom Lift

Screw Gun

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Boom

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature