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

Matthew Whalen

Lionel Blackwell

0

ethnicity

gender

ssn

badge

White

Male

2150

Yes

Job Classification

Union Member?

Apprentice?

Period

Electronic Data

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2017

09/12/2017

10.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Screwdriver

Level

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

0

0

12.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature