Worker Interview - DSA

Worker Interview

General Information

Project Name: Parker Elementary School - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: NAH Sports Flooring, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/01/2018 10:40 AM

Cesar Sandoval

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

9289

No

Job Classification

Union Member?

Apprentice?

Period

Floor Layer/Finisher

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/29/2018

01/31/2018

12.00

12.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Knife

Drills

Chop saw

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

2.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature