Worker Interview - DSA

Worker Interview

General Information

Project Name: Westbury High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Southern Tile & Terrazzo Co.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/05/2017 12:00 AM

Miguel Segura

Jorje Munoz

PWI

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Tile Setter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/05/2017

10/05/2017

0.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Tape Measure

Scraper

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

16.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature