Audit

Violation Section
Select Type of Violation
Safety Violation Categories

Safety Violation Comments/Details

Safety Violation Picture
Performance Deficiency Categories

Performance Deficiency Comments/Details

Policy/Conduct Violation Categories

List Type of Policy/Conduct Violation

Policy/Conduct Violation Comments/Details

Progressive Disciplinary Process
Select Stage of Progressive Disciplinary Process
Employee Signature
Date
Employee Signature
Date
Employee Signature
Date
Supervisor/Safety Department Signature
Date
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.