Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Destin Drywall & Paint, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/18/2017 12:00 AM

Jesus Miranda

Lionel Blackwell

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Drywall Hanger

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/09/2017

10/17/2017

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Clamps

Tape Measure

Knife

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

31.00

Other Work?

Other Training?

Experience

Certifications

0

0

35.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature