Worker Interview - DSA

Worker Interview

General Information

Project Name: Lamar High School - HISD

Prime Contractor: Gilbane Building Company

Subcontrctor: KenMor Electric Company, LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/05/2018 02:58 PM

John Quebe

Lionel Blackwell

None

ethnicity

gender

ssn

badge

White

Male

7200

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Apprentice

No

Yes

2

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/03/2018

01/04/2018

8.00

17.25

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Snips

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature