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    Safety Violation Notice1

    Uploaded by

    rahul kaviraj
    This safety violation notice form documents a violation by an employee, lists the company and individuals involved, outlines a progressive disciplinary process of counseling, written reprimand, and possible termination for repeat offenses, documents the violation, employee explanation, their understanding of safety rules and disciplinary consequences, and requires signatures of the employee and supervisor to be kept on file for two years.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Safety Violation Notice1

    Uploaded by

    rahul kaviraj
    174 views1 page
    This safety violation notice form documents a violation by an employee, lists the company and individuals involved, outlines a progressive disciplinary process of counseling, written reprimand, and possible termination for repeat offenses, documents the violation, employee explanation, their understanding of safety rules and disciplinary consequences, and requires signatures of the employee and supervisor to be kept on file for two years.

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    This safety violation notice form documents a violation by an employee, lists the company and individuals involved, outlines a progressive disciplinary process of counseling, written reprimand, and possible termination for repeat offenses, documents the violation, employee explanation, their understanding of safety rules and disciplinary consequences, and requires signatures of the employee and supervisor to be kept on file for two years.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    174 views1 page

    Safety Violation Notice1

    Uploaded by

    rahul kaviraj
    This safety violation notice form documents a violation by an employee, lists the company and individuals involved, outlines a progressive disciplinary process of counseling, written reprimand, and possible termination for repeat offenses, documents the violation, employee explanation, their understanding of safety rules and disciplinary consequences, and requires signatures of the employee and supervisor to be kept on file for two years.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    SAFETY VIOLATION NOTICE

    Company Name: Date of Violation:


    Supervisor Name: Department:
    Employee Name: Job Title:

    1st Offense 2nd Offense 3rd Offense

    Counseling/Retraining ______ Written Reprimand __________ Termination

    The above-named employee was contacted today regarding the following safety violation:

    The employee’s explanation of his/her behavior is the following:

    I (the employee) understand that safety rules and practices are necessary to reduce accidents and injuries on the job.
    Safe behavior on the job not only protects me, but my fellow workers as well. it is also understood that my employer, by law,
    must impose disciplinary procedures, which could include termination.

    Employee Signature Date

    This form is to be filled out by the manager/supervisor and the employee. The form will be maintained in the employee’s
    personnel file for two years.

    Supervisor/Manager Signature Date

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