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

07/23/2018 10:44 AM

Felipe Lara tello

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Roofer

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/01/2018

07/20/2018

10.00

19.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

56.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

Boom fork

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature