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SAFETY VIOLATION WARNING NOTICE Employee Name: Location of Violation: Department: Date of Incident: Date of warning: Supervisor: Time: Type of Violation: (circle) Failed to Lockout Obstructed access/exit Unsafe Electrical Use Horseplay Previous Warning 1st warning 2nd warning 3rd warning Careless Handling of Material Careless Fire Prevention Improper use of Power Tools Unsafe use of Equipment Verbal yes no yes no yes no Written yes no yes no yes no Date Improper Lifting Failed Safety Rules Other: by Whom Employee Statement Employer Statement Action to Be Taken Warning Dismissal Probation Other Suspension Consequence should incident occur again: I Have Read This Employee Warning Notice And Understand It..
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