Worker Interview - DSA

Worker Interview

General Information

Project Name: Westbury High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Jomar Electrical Contractors

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/30/2017 12:00 AM

Jason garcia

Lionel Blackwell

O

ethnicity

gender

ssn

badge

Hispanic

Male

8749

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/12/2017

06/29/2017

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Monday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Tape Measure

O

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

O

O

3.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature