Title Page

  • Warning Title (Name - Area - #)

  • Employer

  • Date/Time of Incident

  • Job Site Name & Number

  • Prepared By

  • Employee Name

  • Supervisor's Name

  • Witness Name

Warning Details

  • Reason For Warning

  • Details of Incident/Violation

  • Warning Type

  • Has the conduct of the employee's actions been explained to the employee?

  • Additional comments from employee:

  • Additional comments from supervisor:

Signatures

  • Employee signature

  • Supervisor signature

  • Inspector signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.