Worker Interview - DSA

Worker Interview

General Information

Project Name: Sam Houston High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: TAS Commercial Concrete Construction, LLC

Interview Detail

Date

Worker Name

Auditor Name

Remarks

02/28/2018 02:02 PM

Jonny Mondragon

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

5829

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Heavy Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

08/01/2017

08/01/2017

8.00

19.50

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Channel Locks

Tape Measure

Shovel

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

5.00

Back ho

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature