Worker Interview - DSA

Worker Interview

General Information

Project Name: Parker Elementary School - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Tri-Star Glass

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/01/2018 11:05 AM

Jacob Whitman

Lionel Blackwell

None

ethnicity

gender

ssn

badge

White

Male

7090

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/01/2017

01/30/2018

8.00

22.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Caulker

Drills

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

14.00

Boom lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature