Worker Interview - DSA

Worker Interview

General Information

Project Name: Garden Oaks Montessori - HISD

Prime Contractor: B3Ci (JV BETWEEN BALFOUR BEATTY & 3Ci CONSTRUCTION)

Subcontrctor: R&M Service Company

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/11/2018 11:00 AM

Israel Gutierrez

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1368

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

12/11/2017

01/10/2018

8.00

15.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Roller

Paint brush

Broom

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

29.00

Other Work?

Other Training?

Experience

Certifications

None

None

30.00

Scissor lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature