Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Marton Roofing Industries, Ltd.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/28/2017 12:48 PM

Martin Lozano

Victor Bowen

0

ethnicity

gender

ssn

badge

Hispanic

Male

3544

No

Job Classification

Union Member?

Apprentice?

Period

Roofer

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/02/2017

11/27/2017

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Hammer

Drills

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

Fire protection

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature