Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: D & H Masonry, Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/24/2018 11:12 AM

Wilson gomez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Bricklayer Helper

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

01/23/2018

01/23/2018

8.00

15.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Wednesday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hammer

Hand Tools

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

Non

10.00

Boom

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature