Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: TAG Electric Company, L.P.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/10/2018 10:51 AM

Robert Stark

Lionel Blackwell

None

ethnicity

gender

ssn

badge

White

Male

8242

No

Job Classification

Union Member?

Apprentice?

Period

Electrician

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

12/13/2017

01/09/2018

8.00

0.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Screwdriver

Channel Locks

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

37.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature