Worker Interview - DSA

Worker Interview

General Information

Project Name: YWCPA - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: 1 Priority Environmental Services, Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/04/2018 11:19 AM

Victor Lopez

Jorje Munoz

None

ethnicity

gender

ssn

badge

Hispanic

Male

6842

No

Job Classification

Union Member?

Apprentice?

Period

Asbestos Worker

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

12/15/2017

01/03/2018

10.00

16.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Scraper

Saw Saw

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

No

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

30.00

Asbestos

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature