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

11/29/2017 09:07 AM

Oscar Ramirez

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

7682

No

Job Classification

Union Member?

Apprentice?

Period

Sheetmetal Worker-Ductwork

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/17/2017

11/28/2017

8.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Channel Locks

Drills

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

36.00

Other Work?

Other Training?

Experience

Certifications

0

0

6.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature