Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Hou-Tex Newnom Inc., dba Hou-Tex Glass & Mirror

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/30/2018 10:58 AM

Saul Cabrera

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Waterproofer/Caulker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

02/01/2018

10/01/2018

8.00

20.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Caulker

Hand Tools

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature