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 11:24 AM

Nidia de leon

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Female

1234

No

Job Classification

Union Member?

Apprentice?

Period

Painter-Helper

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/11/2018

06/13/2018

8.00

9.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Roller

Paint brush

Broom

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

0.00

0

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature