Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Rob Pelletier Construction, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/27/2017 12:00 AM

Samuel Boatman

Jorje Munoz

0

ethnicity

gender

ssn

badge

Black

Male

7133

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/01/2017

06/01/2017

8.00

22.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

37.00

Boomlift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature