Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: ARC Abatement Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/06/2019 02:30 PM

Agustin gomez

Victor Bowen

ethnicity

gender

ssn

badge

Hispanic

Male

1923

No

Job Classification

Union Member?

Apprentice?

Period

Asbestos Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/14/2019

02/05/2019

9.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Hammer

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

50.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

Abestos

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature