Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: LSM Mechanical

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/06/2017 12:00 AM

Olegario Moreno

Jorje Munoz

0

ethnicity

gender

ssn

badge

Hispanic

Male

6459

No

Job Classification

Union Member?

Apprentice?

Period

Sheetmetal Worker-Ductwork

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/26/2017

11/03/2017

5.00

19.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Snips

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

35.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

Scissor lift, boomlift, forklift

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature