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 10:52 AM

Martin Cuadra

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

6352

No

Job Classification

Union Member?

Apprentice?

Period

Sprinkler Fitter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

02/01/2018

04/06/2018

8.00

21.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Channel Locks

Screwdriver

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

4.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature