Worker Interview - DSA

Worker Interview

General Information

Project Name: Parker Elementary School - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: R2 Insulation, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/17/2017 12:00 AM

Julian perlaza

Victor Bowen

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Semi Skilled/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/30/2017

11/17/2017

8.00

12.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Drills

Hand Tools

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

0

0

1.00

0

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature