___________________________ Date: ___________
[Step 2: e.g., Daily check-ins with the site supervisor for the next two weeks] Disciplenlary Action for Incident on Plymouth S...
On [Date of Incident] at approximately [Time], an incident occurred at the Plymouth St. location. Specifically: ___________________________ Date: ___________ [Step 2: e
(Space for the employee to provide their perspective on the incident) or company safety standards (e.g.
Describe how this incident affected the team, project, or company safety standards (e.g., "This resulted in a 2-hour work stoppage and created a potential hazard for other team members").
[Step 1: e.g., Re-certification in Safety Training by Friday]