Worker Interview - DSA

Worker Interview

General Information

Project Name: Lee High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Memco, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

09/26/2017 12:00 AM

Armando Rodriguez

Jorje Munoz

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Laborer-Skilled

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

06/01/2017

09/22/2017

10.00

13.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Cutting Torch

Shovel

Grinder

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

18.00

Other Work?

Other Training?

Experience

Certifications

None

None

13.00

Operator license

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature