Worker Interview - DSA

Worker Interview

General Information

Project Name: Westbury High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: D & H Masonry, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/30/2017 12:00 AM

Juan torres

Victor Bowen

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/04/2017

06/29/2017

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Wednesday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Boom Lift

Scraper

Forklift

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

10.00

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature