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 11:25 AM

Alfonso medina

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Welder-Pipe

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/05/2017

07/24/2018

8.00

26.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Welding torch

Hand Tools

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

56.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

Scissor boom

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature