Worker Interview - DSA

Worker Interview

General Information

Project Name: Westbury High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: JLG Structures

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/17/2018 12:59 PM

Alexander perdomo

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/03/2018

09/13/2018

8.00

21.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No Response

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Drills

Power Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

11.00

Other Work?

Other Training?

Experience

Certifications

None

None

15.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature