FPC Write-Up

• Conducted on

  Date

• Prepared by

• Location
  Address

• Jobsite Name & Picture

• General Contractor Name

• Foreman

• Superintendent

  Select Alex Flores Carlos Flores Cuco Banda Darren Cormier David Becerra Eddie Rodriguez Freddie Castillo Jose Hernandez Miguel Piedra Rico Montenegro Roger Duran Roel Cortez Michael Urbanczyk

  • Alex Flores
  • Carlos Flores
  • Cuco Banda
  • Darren Cormier
  • David Becerra
  • Eddie Rodriguez
  • Freddie Castillo
  • Jose Hernandez
  • Miguel Piedra
  • Rico Montenegro
  • Roger Duran
  • Roel Cortez
  • Michael Urbanczyk

• Project Manager

  Select Antonio Adame Justin Williamson Will Lockwood Israel Sahagun Chad Stone Ryan Fugate

  • Antonio Adame
  • Justin Williamson
  • Will Lockwood
  • Israel Sahagun
  • Chad Stone
  • Ryan Fugate

• Division

  Select Waterproofing Fireproofing Insulation Fire Stop Warehouse Office

  • Waterproofing
  • Fireproofing
  • Insulation
  • Fire Stop
  • Warehouse
  • Office

• Employee Name(s)

• Employee #(s)

• Picture of Violations

  Media

• Type of Write-Up

  Verbal Warning

  Written Warning

  Serious Warning

  Suspension

  Other

• How many Days is employee being suspended for?

  1/2 Day

  1 Day

  2 Days

  3 Days

  1 Week

• Has employee(s) been warned previously for this violation?

  Yes

  No

  N/A

• When?

• General Violation

  Select Tardiness / Leaving Work Early Absenteeism Violations of Company Policies Drinking /Drugs at work Damage to Material / Equipment / Property Theft Violation of Safety Rules Unsatisfactory Behavior Towards Others / Fighting Insubordination Refusal of Drug / Alcohol Testing Other Poor Safety Attitude

  • Tardiness / Leaving Work Early
  • Absenteeism
  • Violations of Company Policies
  • Drinking /Drugs at work
  • Damage to Material / Equipment / Property
  • Theft
  • Violation of Safety Rules
  • Unsatisfactory Behavior Towards Others / Fighting
  • Insubordination
  • Refusal of Drug / Alcohol Testing
  • Other
  • Poor Safety Attitude

• Description of Violations

Actions

• What will happen if not corrected or happens again?

  Warning

  Write- Up

  Demotion

  Suspension

  Dismissal / Terminated

Acknowledgement of Agreement

• Select I agree with the violations identified in this report I disagree with the violations identified in this report because:

  • I agree with the violations identified in this report
  • I disagree with the violations identified in this report because:

• Why do you disagree?

Employee Signature

• Add signature

  Sign

Manager Signature

• Add signature

  Sign

Witness Signature

• Add signature

  Sign

Finished

• Is this form complete and ready to send?

  Yes

  No