Worker Interview - DSA

Worker Interview

General Information

Project Name: Garden Oaks Montessori - HISD

Prime Contractor: B3Ci (JV BETWEEN BALFOUR BEATTY & 3Ci CONSTRUCTION)

Subcontrctor: Prism Electric, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/19/2018 01:49 PM

Juan Pena

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

6183

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Apprentice

No

Yes

1

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/01/2017

02/17/2028

8.00

12.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Channel Locks

Screwdriver

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

42.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

None

Aware of Postings?

Threatened?

Yes

Yes

Signatures

Employee Signature

Auditor Signature