Title Page
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Conducted on
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Prepared by
IMPORTANT NOTICE: WHEN TICKETS ARE ISSUED ALL DETAILS MUST BE RECORDED ACCURATELY AND ALL FIELDS INCLUDING SUPPORTING EVIDENCE ARE REQUIRED TO BE COMPLETED. REMINDER: WHEN A NOTICE OF RETRAINING IS ISSUED, THE EMPLOYEE MUST BE DISMISSED FOR THE DAY, AND RETURN THE NEXT WORKING DAY WITH THE CERTIFICATE OF COMPLETION. THE CERTIFICATE OF COMPLETION MUST BE ATTACHED TO THE CONCRETE SAFETY MANAGERS LOG UPON RECEIPT FROM EMPLOYEE. EMPLOYEE CAN NOT COMPLETE RETRAINING DURING WORK HOURS. EDT'S MUST BE COMPLETED ON THE DAY IT WAS ISSUED.
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Location
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Supporting evidence
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Select appropriate disciplinary action
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Was the employee sent home for the day? If not please call the office and explain why.( Notice of retraining means the employee needs to be sent home immediately and provide certificate of completion to the Concrete Safety Manager the following work day )
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As per our zero tolerance policy, workers shall be terminated immediately if the following is observed. -Failure to use fall protection when required, Violence or Harrassment of any sort, Use of Drugs or Alcohol during working hours, Creating hazardous / unsafe conditions for themselves, or others that can possibly result in injury or fatal situation, Smoking on site
Notification of EDT to Management
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Notify Management
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Employee Name
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Employee number
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Employees credentials (OSHA card, Certificate of fitness, ID Card, etc.)
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What was observed?
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Name of supervisor
Actions Taken / Remedy:
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