Worker Interview - DSA

Worker Interview

General Information

Project Name: Pilgrim Academy - HISD

Prime Contractor: DT Construction, LP

Subcontrctor: Belknap Plumbing Systems, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/30/2017 08:16 AM

Fabian Gonzales

Victor Bowen

None

ethnicity

gender

ssn

badge

White

Male

2977

No

Job Classification

Union Member?

Apprentice?

Period

Plumber

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/29/2017

11/29/2017

8.00

30.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Channel Locks

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

22.00

Scissor dozer roller

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature