Worker Interview - DSA

Worker Interview

General Information

Project Name: Pilgrim Academy - HISD

Prime Contractor: DT Construction, LP

Subcontrctor: iWorks Personnel

Interview Detail

Date

Worker Name

Auditor Name

Remarks

04/04/2018 02:29 PM

Lateef Bello

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Black

Male

0

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Unskilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/17/2017

04/03/2018

8.00

9.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Scraper

Broom

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

50.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature