Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Duty Construction, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

05/18/2018 02:06 PM

Augustin Rubio

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Heavy Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/14/2017

05/17/2018

9.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Excavator

Roller

Backhoe

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

45.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

Heavy equipment

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature