Employee Warning Record

• Audit Title

• Name of the Worker

• Conducted on

  Date

• Project

• Prepared by

• Location
  Address

• Type of violation

  Select Safety Late Other

  • Safety
  • Late
  • Other

• Select Verbal 1st Written 2nd Written

  • Verbal
  • 1st Written
  • 2nd Written

• Company Statement (Supervisor's Report)

• Supervisor's Signature

  Sign

• Employee Statement

  Select I agree with the company's statement I disagree with the company's statement for the following reasons;

  • I agree with the company's statement
  • I disagree with the company's statement for the following reasons;

• Comment

I have entered my statement of the above matter

• Employee Signature

  Sign

PLEASE BE AWARE THAT THIS REPORT WILL BE KEPT ON FILE AT THE OFFICE, AND THE ISSUE MAY BE DISCUSSED AT A COMPANY HEALTH AND SAFETY MEETING IN THE FUTURE.