Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Greco Structures, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/19/2017 12:00 AM

Saultorres

Victor Bowen

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Carpenter-Form

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/02/2017

10/18/2017

11.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Screwdriver

Drills

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

Yes

55.00

Other Work?

Other Training?

Experience

Certifications

0

0

15.00

0

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature