Worker Interview - DSA

Worker Interview

General Information

Project Name: North Forest High School - HISD

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

Subcontrctor: Fireproof Contractors

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/26/2017 12:00 AM

Julio Cesar Armijo

Jorje Munoz

0

ethnicity

gender

ssn

badge

Hispanic

Male

8533

No

Job Classification

Union Member?

Apprentice?

Period

Waterproofer/Caulker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/24/2017

10/25/2017

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Caulker

Spatula

Trowel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

Boomlift and scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature