Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: AVAdek

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/24/2018 02:37 PM

Jose Juan Jimenez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

6512

No

Job Classification

Union Member?

Apprentice?

Period

Metal Building Assembler

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/24/2018

09/24/2018

12.00

19.25

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Clamps

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

Lifts

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature