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

Rene Garcia

Lionel Blackwell

ethnicity

gender

ssn

badge

Hispanic

Male

4566

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/01/2017

06/29/2017

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Saw Saw

Tape Measure

Channel Locks

none

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

none

none

5.00

scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature