Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Jomar Electrical Contractors

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/17/2017 12:00 AM

Tito Reyes

Victor Bowen

0

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Electrician Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/08/2017

11/16/2017

8.00

17.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Power Tools

Hand Tools

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

24.00

Other Work?

Other Training?

Experience

Certifications

0

0

10.00

Scissor

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature