Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: CFI Mechanical Inc

Interview Detail

Date

Worker Name

Auditor Name

Remarks

01/31/2018 01:43 PM

Cecil Alan Moore

Lionel Blackwell

None

ethnicity

gender

ssn

badge

White

Male

4302

No

Job Classification

Union Member?

Apprentice?

Period

Plumber

Yes

Yes

1

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/01/2017

01/30/2018

8.00

22.13

Pay Type

Pay Day

deductions

OSHA

Paycheck

Wednesday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Wrench

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

3.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature