Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Meredith Environmental, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/24/2019 11:59 AM

Jaime Gonzalez

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

4093

No

Job Classification

Union Member?

Apprentice?

Period

Asbestos Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/02/2019

01/23/2019

10.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Broom

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

46.00

Other Work?

Other Training?

Experience

Certifications

None

None

25.00

Asbestos

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature