Worker Interview - DSA

Worker Interview

General Information

Project Name: Wharton K-8 Dual Language Academy - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: Newcastle Masonry, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

03/21/2018 11:06 AM

Carlos Lopez

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Heavy Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/04/2018

03/20/2018

8.50

22.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Forklift

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

42.50

Other Work?

Other Training?

Experience

Certifications

None

None

14.00

Forklift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature