Worker Interview - DSA

Worker Interview

General Information

Project Name: HSLECJ - HISD

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

Subcontrctor: Raven Mechanical LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/19/2017 12:00 AM

Jonathan Dobbs

Yolanda Gaines

None

ethnicity

gender

ssn

badge

White

Male

1234

Yes

Job Classification

Union Member?

Apprentice?

Period

Plumber

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/20/2017

07/18/2017

8.00

21.50

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Hammer

Cutting Torch

Gloves

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

Safety daily

20.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature