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

07/17/2018 03:03 PM

Justin Riojas

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

9996

No

Job Classification

Union Member?

Apprentice?

Period

Plumber Helper

No

Yes

1

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/14/2018

07/16/2018

10.00

17.70

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Level

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

38.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature