Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Belknap Concrete Cutting & Drilling Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/20/2018 03:14 PM

Felipe Ramirez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Semi Skilled/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/20/2018

09/20/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Paint brush

Hand Tools

Roller

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

64.00

Other Work?

Other Training?

Experience

Certifications

None

None

34.00

Aerial scissor

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature