Worker Interview - DSA

Worker Interview

General Information

Project Name: YWCPA - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Harrrison Alarm Service

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/13/2017 12:00 AM

Ross Holloway

Jorje Munoz

None

ethnicity

gender

ssn

badge

White

Male

5099

Yes

Job Classification

Union Member?

Apprentice?

Period

Laborer-Semi Skilled/Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/01/2017

09/12/2017

8.50

10.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Saw Saw

Nonr

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

0.00

Scissor lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature