Worker Interview - DSA

Worker Interview

General Information

Project Name: Madison High School - HISD

Prime Contractor: Satterfield & Pontikes Construction, Inc

Subcontrctor: Star Insulation

Interview Detail

Date

Worker Name

Auditor Name

Remarks

04/12/2018 11:00 AM

Joel Roman

Lionel Blackwell

None

ethnicity

gender

ssn

badge

Hispanic

Male

9991

No

Job Classification

Union Member?

Apprentice?

Period

Insulator-Piping

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

04/10/2018

04/11/2018

10.00

20.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

Yes

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Tape Measure

Knife

Drills

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

0.00

Other Work?

Other Training?

Experience

Certifications

None

None

8.00

Scissor lift

Aware of Postings?

Threatened?

Yes

No

Signatures

Employee Signature

Auditor Signature