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a E- <br /> Written <br /> Warning — Safety Violation <br /> Page 1 of 1 <br /> This warning is to be completed following a "verbal warning" by the Site Safety and Health <br /> Officer (SSHO) of a safety violation that does not result in an injury or illness. Forward this <br /> document to the OTIE Corporate Safety and Health Manager within 24 hours of the <br /> incident and to the government designated authority (GDA) in the daily Quality Control <br /> report. <br /> Date: Time of Incident(s): <br /> Location: City, State <br /> Name of Project//Contract No.: <br /> Description of the Safety Violation: <br /> What EM 385-1-1 standards were being violated? <br /> List corrective action items, responsible person,scheduled completion date: <br /> NOTE: <br /> A subsequent violation will result in removal of the offending parties from <br /> the job site. <br /> Signature below indicates Employee agreement to this condition. <br /> Print Name Signature Date <br /> SSHO <br /> Employee(s) <br /> Supervisor <br /> Reviewed by: <br /> Corp. SHM William S. Fink, <br /> CIH, CSP, CHMM <br />