Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Derryberry's LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/25/2018 10:51 AM

Mark Abbott

Austin Jonas

None

ethnicity

gender

ssn

badge

White

Male

3551

No

Job Classification

Union Member?

Apprentice?

Period

Welder-Pipe

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/10/2018

07/24/2018

8.00

24.00

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Level

Cutting Torch

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

25.00

Welder, heavy equipment

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature