Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Dobbins Floor Covering

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/08/2019 11:23 AM

Jose lopez

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

0

No

Job Classification

Union Member?

Apprentice?

Period

Floor Layer/Finisher

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/01/2019

08/07/2019

9.50

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Monday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Tape Measure

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

60.00

Other Work?

Other Training?

Experience

Certifications

None

None

5.00

None

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature