Worker Interview - DSA

Worker Interview

General Information

Project Name: Jordan High School - HISD

Prime Contractor: Pepper-Lawson Construction

Subcontrctor: Texas A&M

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/09/2017 12:00 AM

Sergio. Martinez

Victor Bowen

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Concrete Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/06/2017

11/08/2017

10.00

16.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Hammer

Tape Measure

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

55.00

Other Work?

Other Training?

Experience

Certifications

0

0

7.00

Dozer tracker excavation

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature