Worker Interview - DSA

Worker Interview

General Information

Project Name: Austin High School - HISD

Prime Contractor: Pepper-Lawson Construction

Subcontrctor: Joslin Construction

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/28/2017 09:13 AM

Samuel Melgar

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

8653

No

Job Classification

Union Member?

Apprentice?

Period

Concrete Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/21/2017

11/27/2017

10.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Tape Measure

Wrench

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

50.00

Other Work?

Other Training?

Experience

Certifications

0

0

2.00

0

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature