Devine Homes Safety Non-Conformance Notice

• Job Address

• Issued to

• Date

  Date

• Company

• Personnel

• Purpose: to bring unsafe work practices to the attention of subcontractors or suppliers for corrective action

This Safety Non-Conformance Notice relates to:

You are required to take the following Corrective and Preventative Action

• Action Time

  immediately

  within 24 hours

  within 7 days

  other

• Corrective Action Approval (Devine Homes representative)

  Sign

• Select date

  Date

• Acknowledgement (Subcontractor supervisor or leading hand to which the Safety Non-Conformance was issued)

  Sign

• Select date

  Date

• Verification that (when) Corrective Action is completed / effective (Site Manager)

  Sign

• Select date

  Date

ONCE COMPLETED FORWARD THIS SAFETY NON-CONFORMANCE NOTICE TO THE NATIONAL EHS MANAGER

• Safety Non-Conformance Review (National EHS Manager)

  Sign

• Select date

  Date