Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Bamex Painting, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/14/2018 11:02 AM

Anibal Villedas Martinez

Victor Bowen

PW issue

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/02/2018

06/13/2018

12.00

12.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Paint brush

Roller

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature