Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Greco Structures, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

03/19/2019 11:41 AM

Bernaldo Mendoza

Jorje Munoz

Name is Bernardo

ethnicity

gender

ssn

badge

Hispanic

Male

1052

No

Job Classification

Union Member?

Apprentice?

Period

Concrete Finisher/Cement Mason

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/18/2019

03/18/2019

10.00

27.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Level

Trowel

Drills

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

18.00

Heavy operator license

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature