Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Steel Masters, LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/03/2017 12:00 AM

Rogelio Dominguez

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

2444

No

Job Classification

Union Member?

Apprentice?

Period

Ironworker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/21/2017

08/02/2017

8.00

23.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Welding machine

Wire Brush

Clamps

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

0

0

7.00

Yes

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature