Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: D & H Masonry, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

06/19/2019 11:18 AM

Fredrico Ortiz

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Light Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/01/2019

06/18/2019

8.50

20.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Wednesday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Tape Measure

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

43.00

Other Work?

Other Training?

Experience

Certifications

None

None

20.00

Fork lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature