Worker Interview - DSA

Worker Interview

General Information

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

Prime Contractor: Prime Contractors Inc

Subcontrctor: Tomball Sheet Metal L.P.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

12/13/2017 10:47 AM

Jose Valdez

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

2158

Yes

Job Classification

Union Member?

Apprentice?

Period

Sheetmetal Foreman

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/01/2017

12/12/2017

10.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Drills

Snips

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

54.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

Scissor lift, boom lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature