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 12:52 PM

William Henson

Jorje Munoz

None

ethnicity

gender

ssn

badge

Black

Male

2043

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/27/2017

11/27/2017

18.00

21.60

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Shovel

Fire extinguisher

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

35.00

Forklift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature