Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Raven Mechanical LP

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/03/2018 11:12 AM

Robert White

Victor Bowen

Refused to disclose information

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Plumber

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/03/2018

01/03/2018

0.00

0.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Thursday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Channel Locks

Level

Non

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

0

None

17.00

Backhoe, fork

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature