Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Littlefield Brothers Concrete Construction, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/28/2018 10:48 AM

Jose Palacio

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

7505

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/20/2018

02/27/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Level

Drills

Skill saw

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

None

None

7.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature