Safety Violation Form
A safety violation form is filled up by an employee who has violated a particular safety rule of a company because of which he has to face action. In order to make sure that he has understood what safety regulation he has violated, the details of the violation are mentioned in the form and then he is also made aware of the action to be taken against him. Sometimes a safety violation form is also filled up by employees who have just joined an office and are asked to fill up the form so that they know what rules are not meant to be broken for general safety and what to expect if he violates these safety procedures.
Sample Safety Violation Form
Name of company:
Address:
Phone Number:
Email address:
Name of employee:
Name of department:
Designation:
Employee code:
Date of joining:
It has been observed by us that you have been behaving in an unsafe manner contrary to company safety rules which can be harmful to the whole office. We consider the safety of our employees to be very important and in order to set an example and prevent such accidents in the future; it is our policy to enforce company safety rules strictly.
Types of violation:
____________________
____________________
Consequences of the violation:
____________________
____________________
Disciplinary action as a result of violation:
____________________
____________________
I have read and understand the safety rules of the company and agree to act according to the safety rules at all times while working.
Signature of employee:
_______________________
Date:
Signature supervisor:
______________________
Date:
Additional comments
Category: HR Forms
