Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Steel Masters, LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/29/2017 08:50 AM

Octavio Valencia

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Ironworker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

09/01/2017

11/27/2017

8.00

23.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Wrench

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

30.00

Other Work?

Other Training?

Experience

Certifications

None

None

10.00

Boomlift and scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature