HTML Preview Safety Warning Letter To Employee page number 1.
SAFETY VIOLATION WARNING NOTICE
Employee Name: Date of warning:
Location of Violation:
Department: Supervisor:
Date of Incident: Time:
Type of Violation: (circle)
Failed to Lockout Careless Handling of Material Improper Lifting
Obstructed access/exit Careless Fire Prevention Failed Safety Rules
Unsafe Electrical Use Improper use of Power Tools
Horseplay Unsafe use of Equipment Other:
Previous Warning Verbal Written Date by Whom
1
st
warning yes no yes no
2
nd
warning yes no yes no
3
rd
warning yes no yes no
Employee Statement
Employer Statement
Action to Be Taken Warning Probation Suspension
Dismissal Other
Consequence should incident occur again:
I Have Read This Employee Warning Notice And Understand It.
Signature of Employee: Date:
Signature of Employee Issuing the Warning: Date:
Signature of Supervisor: Date: