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

12/13/2017 11:48 AM

Jerome Kilgore

Victor Bowen

None

ethnicity

gender

ssn

badge

Black

Male

=CHAR(048)&719

No

Job Classification

Union Member?

Apprentice?

Period

Plumber

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/11/2017

12/12/2017

7.00

22.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Channel Locks

Scissor Lift

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

35.00

Other Work?

Other Training?

Experience

Certifications

None

None

32.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature