Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Nets of Texas

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/06/2019 11:51 AM

Carlo Villarreal

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

1978

No

Job Classification

Union Member?

Apprentice?

Period

Playground Equip Installer

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/06/2019

11/06/2019

10.00

15.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Hammer

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Scissor boom lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature