Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Winco Masonry

Interview Detail

Date

Worker Name

Auditor Name

Remarks

03/13/2018 03:08 PM

Noe c torres

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer/Stone Mason

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/17/2017

03/12/2018

8.00

25.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Hand Tools

Trowel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

22.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature