Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison 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

02/27/2018 10:29 AM

Jacob William s

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Black

Male

4602

No

Job Classification

Union Member?

Apprentice?

Period

Glaziers

Yes

Yes

3

Start Date

Last Work Date

Hours Last Worked

Pay Rate

12/12/2017

02/26/2018

8.00

17.76

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

Yes-10

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Drills

Tape Measure

Hammer

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

36.00

Other Work?

Other Training?

Experience

Certifications

None

None

1.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature