Worker Interview - DSA

Worker Interview

General Information

Project Name: Lee High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Cherry Moving Co. dba Cherry Demolition

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/26/2017 12:00 AM

Demetrius Peterson

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Black

Male

8269

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/09/2016

09/25/2017

10.00

12.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Wrench

Channel Locks

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

55.50

Other Work?

Other Training?

Experience

Certifications

0

0

18.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature