Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: CFI Mechanical Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/14/2018 10:44 AM

Marco Woodard

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

9951

No

Job Classification

Union Member?

Apprentice?

Period

Plumber Helper

Yes

Yes

5

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/29/2018

06/13/2018

8.00

27.72

Pay Type

Pay Day

deductions

OSHA

Paycheck

Wednesday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Clamps

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature