LIPPERT / KINRO SAFETY VIOLATION VERBAL WARNING

• Document No.

• Conducted on

  Date

• Prepared by

On the Spot Correction Verbal Warning

• Add violation

Violation-

• First, Last Name:

• What division

  Kinro

  Lippert

• Plant number

  Select Plant 19 Plant 30 Plant 26 19 Powder 30 Powder Plant 58 Plant 66 Plant 59

  • Plant 19
  • Plant 30
  • Plant 26
  • 19 Powder
  • 30 Powder
  • Plant 58
  • Plant 66
  • Plant 59

• Plant number

  Select Plant 228 Plant 228G Plant 227 Plant 210 Plant 261 Plant 203 Plant 241

  • Plant 228
  • Plant 228G
  • Plant 227
  • Plant 210
  • Plant 261
  • Plant 203
  • Plant 241

• Line number:

• Violation type

  PPE

  Fork Lift

  Safety Policy Violation

• This is your verbal warning for (PPE)

  Select Failure to utilize safety glasses in a required area Failure to utilize hearing protection in a required area Failure to utilize required appropriate gloves Failure to utilize required weld shield while welding Failure to utilize required full face shield while grinding Failure to wear required steel toe shoes at the workplace Failure to utilize hard hat / bump cap in required area Failure to utilize required reflective wear Failure to utilize respirator PPE or properly

  • Failure to utilize safety glasses in a required area
  • Failure to utilize hearing protection in a required area
  • Failure to utilize required appropriate gloves
  • Failure to utilize required weld shield while welding
  • Failure to utilize required full face shield while grinding
  • Failure to wear required steel toe shoes at the workplace
  • Failure to utilize hard hat / bump cap in required area
  • Failure to utilize required reflective wear
  • Failure to utilize respirator PPE or properly

• This is your verbal warning for: (fork lift)

  Select Failure to submit fork lift inspection sheet Failure to utilize fork lift seatbelt Failure to yield, excessive speed, near miss, ect. Operating a fork lift without operators license or training Failure to follow general rule or safety policy or practice

  • Failure to submit fork lift inspection sheet
  • Failure to utilize fork lift seatbelt
  • Failure to yield, excessive speed, near miss, ect.
  • Operating a fork lift without operators license or training
  • Failure to follow general rule or safety policy or practice

• General Safety Policy Violation OR Unsafe Act

• Supporting photos:

  Media

• Comments:

• This is your verbal warning for failing to follow or comply with company safety policies or practices. It is your responsibility to follow and comply with all company policies and processes to prevent accidents, injuries, and damaged or destroyed company assets. Further negligence may and can result in further disciplinary action; written, suspension, and/ or termination from the company.

• Employee Signature:

  Sign

• Supervisor Signature:

  Sign