Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Jomar Electrical Contractors

Interview Detail

Date

Worker Name

Auditor Name

Remarks

08/22/2019 11:09 AM

Salomon Huerta

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

3222

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/12/2019

08/21/2019

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Drills

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Fork lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature