Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Tomball Sheet Metal L.P.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/24/2018 03:27 PM

Agustin Franco

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Sheetmetal Worker-General

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/01/2017

01/23/2018

8.00

0.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Tape Measure

Screwdriver

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature