Information
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Notice Title
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Employee
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Division
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Violation Date
Violation Details
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EMP Name:
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Division:
- Restoration
- Facade
- New Construction
- Service
- Warehouse
- Shop
- Rolling Along
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Supervisor Name:
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Violation Location:
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Violation Type:
- CWC Policy
- CWC Procedure
- PPE
- Safety Issue
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Details of Violation:
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Corrective Action Required or Taken
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Time Frame for Improvement/Correction
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Consequences if Repeated?
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Penalty Steps are as follows: 1.) Verbal Warning 1, 2.) Verbal Warning 2, 3.) Written Warning 1 w/1 Day No Work or Pay, 4.) Written Warning 2 w/3 Days No Work or Pay, 5.) Written Warning 3 w/5 Days No Work or Pay, 6.) Suspension/Termination Recommendation
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Penalty Issued:
- Verbal Warning 1
- Verbal Warning 2
- Written Warning 1
- Written Warning 2
- Written Warning 3
- Suspension/Termination
- Other
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Witness to Notice:
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Witness Signature:
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Employee Signature:
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Select date
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Safety Director Signature
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Select date
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Comments:
