Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: JLG Structures

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/26/2017 12:00 AM

Luis Suarez

Victor Bowen

None.

ethnicity

gender

ssn

badge

Hispanic

Male

6756

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

Yes

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/25/2017

06/22/2017

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Hand Tools

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

38.00

Other Work?

Other Training?

Experience

Certifications

No

None

40.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature