Worker Interview - DSA

Worker Interview

General Information

Project Name: Parker Elementary School - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Harrrison Alarm Service

Interview Detail

Date

Worker Name

Auditor Name

Remarks

12/01/2017 09:16 AM

Evan Szego

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Other

Male

9156

No

Job Classification

Union Member?

Apprentice?

Period

Electronic Data

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/13/2017

11/30/2017

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Screwdriver

Drills

Tape Measure

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

0

0

2.00

Scissor

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature