Worker Interview - DSA

Worker Interview

General Information

Project Name: Westbury High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: TX Lonestar Mechanical

Interview Detail

Date

Worker Name

Auditor Name

Remarks

12/01/2017 12:13 PM

Bryan Flores

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

6258

No

Job Classification

Union Member?

Apprentice?

Period

Pipe Fitter

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

07/01/2017

11/30/2017

8.00

28.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Saw Saw

Wrench

0

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

Yes

60.00

Other Work?

Other Training?

Experience

Certifications

0

0

0.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature