Worker Interview - DSA

Worker Interview

General Information

Project Name: Garden Oaks Montessori - HISD

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

Subcontrctor: Prism Electric, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/02/2017 12:00 AM

Darwin Doblado

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

2014

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Apprentice

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/27/2017

11/01/2017

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Screwdriver

Channel Locks

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

8.00

Other Work?

Other Training?

Experience

Certifications

0

0

5.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature