SH - OHS Improvement Notice

• Prepared by

• Project

• Location
  Address

Subcontractor Name

• Subcontractor Name

• Employee Name

• Location of incident

Violation

• Picture of item in question

  Media

• Date & Time

  Date

• Type of warning

  Verbal Warning

  Written Warning

  Other

• Other description:

SAFETY (check all that apply)

• Unsafe act

• Improper Safety attire or Failure to wear PPE

• Working in Unsafe conditions or improper housekeeping

• Failure to follow safety procedures

• Failure to intervene or address an unsafe act of another

• Using unsafe electrical equipment

• Failure to comply with regular equipment/lead testing & tagging.

Compliance Agreement

• I understand that my actions or equipment has been noted as non compliant to work on Sienna Homes sites. I have been given this warning to change my work methods and/or to ensure my equipment electrical safety is compliant. A follow up inspection on equipment and lead tagging will be completed in the next 14 days. <br> I understand that if I failure to comply, I may be unable to work on all Sienna Homes building sites.

  Yes

  No

  N/A

• Signature

  Sign