Scribd
Upload
17 views1 page

Safety Violation Notice

The document is a Safety Violation Notice for an employee at Dave Bessine Electric, detailing the disciplinary actions for safety violations ranging from counseling to termination. It includes sections for the employee's explanation and signatures from both the employee and supervisor. The form will be kept in the employee's personnel file for two years.

Uploaded by

shawnadbe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
17 views1 page

Safety Violation Notice

The document is a Safety Violation Notice for an employee at Dave Bessine Electric, detailing the disciplinary actions for safety violations ranging from counseling to termination. It includes sections for the employee's explanation and signatures from both the employee and supervisor. The form will be kept in the employee's personnel file for two years.

Uploaded by

shawnadbe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

SAFETY VIOLATION NOTICE

Company Name: Dave Bessine Electric Date of Violation:


Supervisor Name: Department:
Employee Name: Job Title:

1st Offense 2nd Offense 3rd Offense 4th Offense

Counseling/Retraining Written Reprimand Suspension 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 Signature Date

You might also like