[MUTLAQ AL-GHOWARI Co.

for Contracting Limited] Safety System Manual

SAFETY VIOLATION NOTICE

Project Name: ‫انشاء منظومة اعادة استخدام مياه الصرف الصحي المعالجة بمدينة بريدة‬

3.9 EMPLOYEE WARNING

EMPLOYEE
NAME:

DATE OF WARNING:
1ST NOTICE:
2ND NOTICE:

TIME OF VIOLATION:
DATE:

LOCATION AND #:
SAFETY VIOLATION:
(Explain)

3.10 VIOLATION CONSIDERED TO BE:

Extremely Serious……………… Serious…………….. Minor…………….. Other………………

COMMENTS:

WITNESS: REPORTED BY…….………………………………………………………

DATE:
SUPERVISOR’S COMMENTS:

SUPERVISOR’S SIGNATURE:
DATE:
EMPLYEE’S COMMENTS:

EMPLOYEE’S SIGNATURE:
DATE:

3.11 CORRECTION

What action has or will be taken to prevent recurrence? (List then place an “X” by completed items
date.) ………..……………………………… …………………………………………………………………… ……………… ……………
……………………………………………………………………………………………………………………………………………………….

MANAGER ………………………………………………………………………………………DATE: ……………………………………

SAFETY COORDINATOR …………………………………………………………………..DATE: ……………………………………

COPIES TO: OFFICE (ORIGINAL) – SAFETY COORDINATOR - EMPLOYEE

All Right Reserved */2011