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

12/13/2017 09:10 AM

Raul Perez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer/Stone Mason

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/13/2017

12/12/2017

8.00

25.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Trowel

Mixer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

4.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

none

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature