Worker Interview - DSA

Worker Interview

General Information

Project Name: HSPVA - HISD

Prime Contractor: McCarthy Building Company

Subcontrctor: Prism Electric, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/31/2017 12:00 AM

Angel Cumpian

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

9231

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/07/2001

10/30/2017

10.50

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Channel Locks

Screwdriver

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

48.00

Other Work?

Other Training?

Experience

Certifications

0

0

1.00

0

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature