Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: J.R. Jones Roofing

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/17/2018 11:25 AM

Carlos amaya

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

2012

No

Job Classification

Union Member?

Apprentice?

Period

Roofer

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/01/2017

07/16/2018

10.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Screw Gun

Level

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

50.00

Other Work?

Other Training?

Experience

Certifications

None

None

4.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature