Worker Interview - DSA

Worker Interview

General Information

Project Name: Washington High School - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: MAA Mechanical Services

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/28/2018 10:55 AM

Jorge Aguilar

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Welder-Pipe

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/01/2017

02/27/2018

8.00

20.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Wire Brush

Welding torch

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature