Worker Interview - DSA

Worker Interview

General Information

Project Name: HSPVA - HISD

Prime Contractor: McCarthy Building Company

Subcontrctor: Prism Electric, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/25/2018 10:07 AM

Donald Randoff

Jorje Munoz

None

ethnicity

gender

ssn

badge

White

Male

2498

No

Job Classification

Union Member?

Apprentice?

Period

Electrician

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/15/2018

01/24/2018

8.00

24.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Screw Gun

Channel Locks

Clins

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

Scissor lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature