Details

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

  • Type of breach

  • Enter specific details of breach -

  • Add any relative photos / media

Signature

  • Is this the 3rd and final stike?

  • 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

  • Person filling out form and witnessing

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