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[PROGRAM NAME]
Safety Notice
On [date], [student name and ID] was involved in an incident that is a
contravention of the safety requirements set out by the Institute and the [course/program]
This Safety Notice is being executed according to BCIT Policy 5102, Student
Code of Conduct (non-academic) and Policy 7512, Occupational Health and Safety. It is
the responsibility of each student at BCIT to be aware of BCIT’s policy requirements and
to abide by these requirements.
Reported Safety Contravention:
Corrective Action:
The incident was discussed with the student and the student was counselled on
what is deemed appropriate and inappropriate safety practices at the British Columbia
Institute of Technology.
I have been notified that the behaviour described above is inconsistent with
BCIT’s expectations of safe conduct.
Student Initial
Student Initial
I have been advised that I must comply with BCIT safety requirement in all
future activities.
I have received either a paper copy or have been directed to a URL where I may
review BCIT’s Safety expectations.
Student Initial
I have been notified that further or repeated incidents of unsafe conduct
may result in my removal from the program or my suspension from BCIT.
Student Initial
Instructions: Provide one copy to the student and keep one copy on department files.
____________________________________________________________________________________________________________
I, [student name and ID] confirm receipt of this Safety Notice.
Date of this notice:
Notice #:
Student Signature:
Instructor Signature:
Instructions: Provide one copy to the student and keep one copy on department files.
____________________________________________________________________________________________________________
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