Document No: Revision No: 0

Issue No: 1 SAFETY VIOLATION NOTICE Date Prepared: May 5, 2021

Effective Date: May 20, 2021

Project: METROPOLITAN PARK RE-DEVELOPMENT PROJECT DATE:

Location: METROPOLITAN PARK, PASAY CITY TIME:

Smoking anywhere/Anytime Sleeping, Horse Playing while on duty

Habitual Tardiness Unsanitary Act

Not Wearing Hard Hat Vandalism, Gambling

Not Wearing Proper Uniform Act of Lasciviousness, Sexual Harassment

Not Wearing Safety Footwear Use of Cellphone while on duty

Refusal to comply with supervisor instruction Unauthorized Operation of Equipment &

Tools
Failure to Comply Housekeeping Entering Site under the influence of
Alcohol
Bad mouthing, insulting, Bullying others Others Specified Below:

Details of Violation:

Name of Violator: Designation:

Recommendation:

Prepared By:

Name Designation Signature Date/Time

Noted By:

Name Designation Signature Date/Time

Approved By:

Name Designation Signature Date/Time

Remarks:

Conforme By:

Signature Over Printed Name