Free Workplace Safety Violation Notice Template
Workplace Safety Violation Notice
Date of Issue: [Month Day, Year]
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Employee Information |
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Employee Name: |
[Employee Name] |
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Job Title: |
[Employee Job Title] |
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Department: |
[Employee Department] |
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Supervisor Name: |
[Supervisor Name] |
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Violation Details |
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Date of Violation: |
[Date of Violation] |
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Location of Violation: |
[Warehouse Section A] |
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Description of Violation: |
Failure to wear mandatory personal protective equipment (PPE) during operational hours, violates the company's PPE policy. |
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Previous Warnings (if applicable) |
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First Warning: |
A verbal warning was issued on [Previous Warning Date] for a similar violation. |
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Second Warning: |
Written warning issued on [Previous Warning Date]. |
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Consequences of the Violation |
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As per the company's safety policy, this third violation results in a two-day suspension without pay. |
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Corrective Action Required |
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Action: |
Attend a mandatory safety training session. |
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Deadline for Completion: |
[Deadline Date] |
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Acknowledgment of Notice |
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I acknowledge receipt and understanding of this notice and the necessity to adhere to company safety policies. Employee Signature: [Employee Signature] Date: [Month Day, Year] |
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Supervisor and Safety Officer Section |
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Supervisor’s Comments: |
Emphasis on the importance of following safety protocols consistently. |
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Safety Officer's Comments: |
Recommendation for periodic safety audits in the department. |
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Signatures and Dates: |
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Supervisor: [Supervisor Signature], [Date] Safety Officer: [Safety Officer Signature], [Date] |
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Additional Documentation |
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Attached: Photographs of the violation, copy of the safety policy. |
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Follow-up and Review |
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Scheduled Review Date: |
[Scheduled Review Date] |
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Instructions for Non-compliance: |
Further non-compliance may result in additional disciplinary actions up to termination. |
