Worker Interview - DSA

Worker Interview

General Information

Project Name: Westbury High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Bamex Painting, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/16/2017 12:00 AM

Javier Escobedo

Jorje Munoz

Paid biweekly

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Painter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/01/2017

07/15/2017

8.00

12.89

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Paint brush

Spray Gun

Roller

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Boomlift and scissor lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature