5.3 EMPLOYEE VIOLATION RECORD (FORM)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Employee Name:

• Date of Warning:

• Warning issued by:

• Position:

VIOLATION TYPE: (1)Absenteeism (2)Intoxication (3)insubordination (4)Inability to Perform Work

• Other:

• Company Statement / Supervisor(s) Report:

• Signature:

  Sign

Employee Statement:

• Agreement with Company's statement (Initial)

  Sign

• Disagree with Company's statement (Initial)

  Sign

Statement of Disagreement:

• Employee Signature:

  Sign

NOTE: This report will be kept on file at Armour-Clad Contracting Inc. Head office and the issue(s) may discussed at a company Health and Safety meeting.