Worker Interview - DSA

Worker Interview

General Information

Project Name: Westbury High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Prism Response

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/02/2019 02:53 PM

Marcos Orta

Jorje Munoz

Last name is Horta

ethnicity

gender

ssn

badge

Hispanic

Male

7270

No

Job Classification

Union Member?

Apprentice?

Period

Asbestos Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/27/2019

07/01/2019

10.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Saw Saw

Hammer

Broom

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

20.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

Scissor lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature