Worker Interview - DSA

Worker Interview

General Information

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

Prime Contractor: Prime Contractors Inc

Subcontrctor: T. Bradshaw Plumbing

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/28/2017 12:57 PM

Amir Montgomery

Victor Bowen

0

ethnicity

gender

ssn

badge

Black

Male

5306

No

Job Classification

Union Member?

Apprentice?

Period

Plumber Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/13/2017

11/27/2017

9.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Drills

Bandsaw

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

28.00

Other Work?

Other Training?

Experience

Certifications

0

0

3.00

0

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature