Worker Interview - DSA

Worker Interview

General Information

Project Name: HSLECJ - HISD

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

Subcontrctor: LMI Painting LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/01/2017 12:00 AM

Marvin Rios

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

4982

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/16/2017

10/31/2017

9.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Paint brush

Caulker

Ladder

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

45.00

Other Work?

Other Training?

Experience

Certifications

0

0

13.00

Scissor

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature