Worker Interview - DSA

Worker Interview

General Information

Project Name: Eastwood Academy - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: R&E Painting

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/08/2017 12:00 AM

Jesus antonio

Victor Bowen

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/15/2017

11/07/2017

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Roller

Paint brush

Power Tools

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

0

0

4.00

Scissor

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature