Worker Interview - DSA

Worker Interview

General Information

Project Name: Wharton K-8 Dual Language Academy - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: Littlefield Brothers Concrete Construction, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/05/2018 11:03 AM

Preciliano Gomez

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

3564

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/01/2017

01/04/2018

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Saw Saw

Level

Drills

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

15.00

Excavator, forklift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature