Template

Safety Violation Form

by Mike Hall, from the Community

10+

Use this Safety Violation Form to document and address safety policy breaches on job sites. Capture site and employee details, date of infraction, and a detailed explanation of the violation. The form supports progressive discipline, from verbal and written warnings to suspensions or termination for severe or repeated offenses. Record corrective actions, note immediate danger incidents, and secure supervisor sign-off to ensure accountability and compliance. Designed for construction and field operations, this template helps standardize reporting, reinforce safety policies, and improve incident tracking and training follow-ups.

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Digitize any process, procedure or policy

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Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Safety Violation Notice Template
Use this Safety Violation Notice to formally record workplace safety breaches and drive corrective action. Capture the date of occurrence, responsible contractor or subcontractor, employee name, location, and a clear description of the violation. Add photos or evidence, note required actions, track resolution status, and collect the employee’s signature to acknowledge receipt. Ideal for construction and field operations to maintain compliance and improve safety performance.
by Ric Cumming, from the Community
Downloads: 10+
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Template
CWC Safety Procedure and Violation Notice
Use this construction safety procedure and violation notice to record incidents, identify the violation type policy, procedure, PPE, or safety issue and assign corrective actions. Capture employee and supervisor details, division and location, time frames for improvement, and apply penalty steps from verbal warnings to suspension. Collect signatures from witnesses, employees, and the safety director, and add comments. Adapt the template to your site practices and jurisdictional requirements.
by Kelly Phillips, from the Community
Downloads: 0
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Template
Safety Violation Warning
Use this Safety Violation Warning template to record unsafe acts and conditions on construction sites. Capture worker details, job information, warning date, severity level, and violation types such as missing PPE, fall exposure, improper equipment use, housekeeping, and more. Add notes and corrective actions, attach media, and collect signatures from the co-worker, supervisor, and safety officer to drive accountability and improve site compliance.
by Felix Aleman, from the Community
Downloads: 30+
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Template
Safety Violation Write-up Template
This Safety Violation Write-up template helps supervisors document workplace safety incidents consistently. Record employee details, date and time, type of warning, unsafe acts, PPE or housekeeping issues, and failure to follow procedures. Attach a photo of the violation, add notes, and capture agreement or disagreement statements from the employee. Include required signatures to formalize the report and guide corrective actions. Suitable for industrial and field environments seeking a clear, repeatable process for safety compliance.
by Stan Gray, from the Community
Downloads: 30+
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Safety Violation Form

About author

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Safety Violation Notice Template

CWC Safety Procedure and Violation Notice

Safety Violation Warning

Safety Violation Write-up Template

You might also like

Safety Violation Notice Template

CWC Safety Procedure and Violation Notice

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Safety Violation Write-up Template