Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Accurate Glass Systems of Texas, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/31/2018 02:02 PM

Clemnte ramirez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

7395

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/03/2018

10/30/2018

8.00

22.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Hand Tools

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

60.00

Other Work?

Other Training?

Experience

Certifications

None

None

30.00

Scissor boom fork

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature