Worker Interview - DSA

Worker Interview

General Information

Project Name: North Forest High School - HISD

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

Subcontrctor: Memco, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/24/2017 12:00 AM

Clettris Bradwell

Yolanda Gaines

None

ethnicity

gender

ssn

badge

Black

Male

1234

Yes

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/13/2017

07/22/2017

9.00

10.00

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Shovel

Hand Tools

Broom

Gloves

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

56.00

Other Work?

Other Training?

Experience

Certifications

None

None

15.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature