Date / Time of Walk starting
Disciplinary Action given

First and last name of worker

Description of violation

Level of severity (could be escalated if additional violations exist in the disciplinary log)


Foreman Signature indicating the violation was explained to the worker and understood.
Check the area in accordance with the below criteria.
Any corrective actions should be documented in the next section.
Any marked "No" should have a detailed explanation.
Corrective Action
Area Location

Insert Column Location or other Comments Here for Clarification

Detail issue

Owning contractor
Photo if applicable

Owner of corrective action

Detail Corrective Action needed

Due date

Check box if verified complete

Time of walk finishing
Name of Auditor and Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.