Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Revitalize Maintenance LLC.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/06/2019 11:15 AM

Ariel Medina

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

05/01/2019

06/04/2029

11.00

12.00

Pay Type

Pay Day

deductions

OSHA

Cash

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Shovel

Grinder

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

5.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature