Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Backwater Fence, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/31/2019 11:41 AM

Roberto Ruiz

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Landscape Laborer-Unskilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/30/2019

10/31/2019

9.00

10.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Hammer

Broom

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

0.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature