Worker Interview - DSA

Worker Interview

General Information

Project Name: Worthing High School (Phase II) - HISD

Prime Contractor: Prime Contractors Inc

Subcontrctor: Metal Specialties

Interview Detail

Date

Worker Name

Auditor Name

Remarks

04/17/2018 01:39 PM

Mark Barnaba

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Black

Male

7293

No

Job Classification

Union Member?

Apprentice?

Period

Roofer

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/01/2017

04/16/2018

8.50

12.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

44.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature