Worker Interview - DSA

Worker Interview

General Information

Project Name: Parker Elementary School - HISD

Prime Contractor: Patriot Contracting, LLC

Subcontrctor: Patriot Contracting, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/20/2018 11:42 AM

Carolina Romero

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Female

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

02/08/2018

02/18/2018

8.00

10.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Broom

Shovel

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

43.00

Other Work?

Other Training?

Experience

Certifications

None

None

4.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature