Worker Interview - DSA

Worker Interview

General Information

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

Prime Contractor: Prime Contractors Inc

Subcontrctor: Winco Masonry

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/28/2017 01:17 PM

Marvin Otoniel Avila

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/01/2017

11/27/2017

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Shovel

Scraper

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature