Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: CFI Mechanical Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

11/29/2017 02:12 PM

Eric Perry

Victor Bowen

none

ethnicity

gender

ssn

badge

White

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Plumber

Yes

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/13/2017

11/28/2017

8.00

34.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

No

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Hand Tools

none

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

32.00

Other Work?

Other Training?

Experience

Certifications

none

none

0.00

none

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature