Worker Interview - DSA

Worker Interview

General Information

Project Name: Davis (Northside) High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Hou-Tex Newnom Inc., dba Hou-Tex Glass & Mirror

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/21/2018 10:56 AM

Miguel lopez

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1805

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

Yes

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

11/01/2017

02/19/2018

40.00

28.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

Yes-30

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Hand Tools

Level

Tape Measure

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

40.00

Other Work?

Other Training?

Experience

Certifications

None

None

6.00

Scissor boom

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature