Worker Interview - DSA

Worker Interview

General Information

Project Name: HSPVA - HISD

Prime Contractor: McCarthy Building Company

Subcontrctor: J&n

Interview Detail

Date

Worker Name

Auditor Name

Remarks

04/05/2018 10:23 AM

Rogelio Jacome Burgos

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/30/2018

04/04/2018

8.00

14.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Bandsaw

Saw Saw

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

8.00

Other Work?

Other Training?

Experience

Certifications

None

None

4.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature