Worker Interview - DSA

Worker Interview

General Information

Project Name: Garden Oaks Montessori - HISD

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

Subcontrctor: A&N insurlator

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/11/2018 11:55 AM

Pablo Perez

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Insulator-Building

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/01/2017

01/10/2018

10.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Caulker

Tape Measure

Drills

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

17.00

Scissor

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature