Worker Interview - DSA

Worker Interview

General Information

Project Name: HSPVA - HISD

Prime Contractor: McCarthy Building Company

Subcontrctor: Prism Electric, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/04/2018 10:01 AM

Oscar Ortiz

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Apprentice

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/14/2017

01/03/2018

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Screw Gun

Hand Tools

Drills

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

30.00

Other Work?

Other Training?

Experience

Certifications

No

No

8.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature