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

06/26/2018 02:17 PM

Roque Resendiz

Austin Jonas

None

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

06/14/2018

06/25/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Roller

Paint brush

Ladder

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

Boom lift, fork lift, etc

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature