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

12/15/2017 02:20 PM

Bobby evans

Victor Bowen

None

ethnicity

gender

ssn

badge

White

Male

3486

No

Job Classification

Union Member?

Apprentice?

Period

Plumber

Yes

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/01/2017

12/14/2017

8.00

35.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Level

Channel Locks

Hand Tools

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

0

None

20.00

Scissor boom

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature