SAFETY VIOLATION NOTICE

Issued To : Notice No :
Copy To : CC :
Project : Contract No :
Trade : Date Of Issue :

DESCRIPTION

This is inform you that you were found doing the following unsafe work Practices
□ No Wearing Safety Helmet □ Tempering the Safety signs & Warning
□ No Wearing Safety Harness □ Sleeping on Duty
□ Thronging Material from height □ Not Attending safety meeting s
□ smoking is Misbehavior □ Over speeding of Vehicle at site
□ Negligence on part of employee □ Not Following safety Instructions
□ Causing damage to site property □ Not Following the PPEs provided for particular job
□Not Following the safety precautionary measures
Others ( Justify):

The above mentioned unsafe work particulars violate the safety rules and regulations . Hence you are
giving this safety violation notice

Site Manager : Signature : Date :

ACCEPTANCE

I have received this notice and I am aware that I have violated the safety Rules & Regulations of unsafe
working practice and enumerated

I Will do my best to conform to the safety Rules & Regulations to avoid accidents and keep the working
environment

Employee : Signature: Date:

QEHS-01-010-A1