Worker Interview - DSA

Worker Interview

General Information

Project Name: North Forest High School - HISD

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

Subcontrctor: Prism Electric, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/24/2017 12:00 AM

Helen Lazo

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Female

6608

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Apprentice

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/20/2017

07/21/2017

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Tuesday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Power Tools

Hand Tools

Drills

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

None

None

5.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature