Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: The Theut Company LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/27/2017 12:00 AM

Filiberto Rodriguez

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

7103

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/23/2017

10/26/2017

10.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Tuesday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Tape Measure

Saw Saw

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

0

0

2.00

scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature