Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Summers Drywall Services

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/04/2018 01:42 PM

Paula Riascos

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Female

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/01/2018

05/03/2018

8.00

12.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Hammer

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature