Employee Misconduct

• Document No.

• Project Number

• Project Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Violation

• What type of violation?

  Attendance

  Company Policy

  Safety Violation

  Insubordination

  Performance

• What type of attendance violation was committed?

  Tardy/Late

  Quit early w/o permission

  No call/No show

  Late return from lunch/break

• What time did the employee report to work?

  Date

• How many minutes late to return to work?

• How many minutes early did the employee leave?

• What Company Policy did the employee violate?

  Select Substance Abuse Harassment Violence Vehicle Use Employee Conduct Other

  • Substance Abuse
  • Harassment
  • Violence
  • Vehicle Use
  • Employee Conduct
  • Other

• If it is suspected that the Substance Abuse Policy is being violated, contact Steve Chandler or Ryan Norder immediately following the completion of this report.

• What best describes the suspicion for a Substance Abuse violation?

  Select Failed Drug/Alcohol Screen Possession of Drugs/Alcohol Slurred Speech or Other Imparement

  • Failed Drug/Alcohol Screen
  • Possession of Drugs/Alcohol
  • Slurred Speech or Other Imparement

• What Safety Policy did the employee violate?

  Select Safety Glasses/Face Shield Hard Hat Fall Protection Other

  • Safety Glasses/Face Shield
  • Hard Hat
  • Fall Protection
  • Other

• What Fall Protection system is being used?

  Select Controlled Access Zone/Safety Monitor Guardrail SRL Other

  • Controlled Access Zone/Safety Monitor
  • Guardrail
  • SRL
  • Other

• Which Fall Protection violation?

  Select Outside of the CAZ w/o a Safety Monitor Wearing Harness Improperly Improper or No anchor for SRL No Fall Protection Measure Other

  • Outside of the CAZ w/o a Safety Monitor
  • Wearing Harness Improperly
  • Improper or No anchor for SRL
  • No Fall Protection Measure
  • Other

• Picture of the violation

  Media

Description of Violation

• Date and time of incident:

  Date
• Location of incident:
  Address

• Description of the violation/misconduct.

Action Taken

• I recommend that the employee be:

  Warned

  Suspended

  Terminated

  Other

• This is the employee's:

  First Warning

  Second Warning

  Third Warning

  Other

• How many times has the employee been warned?

• Recommended Action

Acknowledgement

• Supervisor's Signature

  Sign

• Employee's Signature

  Sign