Worker Interview - DSA

Worker Interview

General Information

Project Name: Wilson Montessori School - HISD

Prime Contractor: Drymalla Construction Co. Inc.

Subcontrctor: Jim Hoffman Tile, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/05/2018 01:49 PM

Monica tello

Victor Bowen

Pw issue, cash

ethnicity

gender

ssn

badge

Hispanic

Female

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Semi Skilled/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/02/2018

01/05/2018

8.00

10.00

Pay Type

Pay Day

deductions

OSHA

Cash

Saturday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Spatula

Drills

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

5.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature