Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: LMI Painting LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/31/2018 11:18 AM

Jose Luis Orellana

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

12/15/2017

01/30/2018

10.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Spray Gun

Paint brush

Roller

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

30.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature