Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Destin Drywall & Paint, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

07/09/2019 11:46 AM

Pedro Medina

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Drywall Hanger

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

02/05/2019

07/08/2019

10.00

19.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hand Tools

Knife

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

46.00

Other Work?

Other Training?

Experience

Certifications

None

None

28.00

Lift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature