Worker Interview - DSA

Worker Interview

General Information

Project Name: HSLECJ - HISD

Prime Contractor: B3Ci (JV BETWEEN BALFOUR BEATTY & 3Ci CONSTRUCTION)

Subcontrctor: Chief Fire Systems, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

04/09/2018 10:56 AM

Eric Salazar

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

6316

No

Job Classification

Union Member?

Apprentice?

Period

Sprinkler Fitter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/29/2018

04/06/2018

8.00

26.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

15.00

Scissor boom

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature