Worker Interview - DSA

Worker Interview

General Information

Project Name: HSLECJ - HISD

Prime Contractor: B3Ci (JV BETWEEN BALFOUR BEATTY & 3Ci CONSTRUCTION)

Subcontrctor: Chief Fire Systems, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

12/18/2017 11:08 AM

Johnny cervantes

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

4245

No

Job Classification

Union Member?

Apprentice?

Period

Sprinkler Fitter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/29/2007

12/15/2017

8.00

25.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Drills

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

11.00

Fire

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature