Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Hou-Tex Newnom Inc., dba Hou-Tex Glass & Mirror

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/06/2019 11:41 AM

Komlavi Gadegbekou

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Black

Male

4348

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

Yes

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

03/01/2019

06/04/2019

8.00

23.77

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Tape Measure

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

12.00

Scissor lift boom lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature