Nautical Roofing STRIKE NOTICE

• Project Name and/or Job Number (e.g. Coles Nambour or NR-1064)

• Site Address

• Conducted on

  Date

• Nautical Representative

• Location
  Address

• Document No.

Worker / Contractor's Details and History

• Company Name (if applicable)

• Name

• How many WH&S breaches previously?

Details of WH&S Breach

• Date and time of breach

  Date

• Type of breach

  Select inadequate PPE incomplete forms / paperwork Abusive behavior Drugs / Alcohol Out of date equipment / registers Un-licensed activity

  • inadequate PPE
  • incomplete forms / paperwork
  • Abusive behavior
  • Drugs / Alcohol
  • Out of date equipment / registers
  • Un-licensed activity

• Enter specific details of breach -

• Add any relative photos / media

  Media

Signature

• Is this the 3rd and final stike?

  Yes

  No

• I understand that this is my 3rd and final strike and under Nautical Roofing's 3 strike policy I am no longer permitted to work on any Nautical Roofing job sites.

• I hereby accept that the details on this form are true and correct and will rectify my actions to conform with all Nautical Roofing's procedures and policies.
  I understand that Nautical Roofing only allows 3 strikes before no longer being able to access their sites.

• Person accepting strike

  Sign

• Person filling out form and witnessing

  Sign