Worker Interview - DSA

Worker Interview

General Information

Project Name: Dowling Middle School (Lawson) - HISD

Prime Contractor: Turner Construction Company

Subcontrctor: Memco, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/24/2018 02:09 PM

Sydenstricker,Jeffery

Victor Bowen

None

ethnicity

gender

ssn

badge

White

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Unskilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

12/15/2017

01/23/2018

10.00

10.00

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Broom

Shovel

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

34.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature