Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Jomar Electrical Contractors

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/02/2018 12:32 PM

Manuel Diaz

Austin Jonas

None

ethnicity

gender

ssn

badge

Hispanic

Male

7430

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Apprentice

No

No

2

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/05/2018

08/01/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Debit

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Drills

Screwdriver

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

48.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

Electrician

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature