Windstar Lines – Warning-Notification Manager InformationEnter your name (manager):(Required) First Last Enter your Email Address (manager):(Required) Employee InformationEmployee Name:(Required) First Last Employee Email Address:(Required) Please select the driver's Branch Location(Required)CarrollBloomingtonBoiseBurlingtonCedar RapidsChicagoDes MoinesDubuqueGo TeamKansas CityLas VegasLebanonLincolnOrlandoPhoenixRockfordSaint LouisSioux FallsPlease select the topic for the Warning Letter(Required)Please selectViolation of Cardholder AgreementPreventable AccidentSamsara Safety Score Improvement PlanHours of Service ViolationFailing to Submit Medical CertificateHand-held Mobile DeviceFailing to Report Moving ViolationSmoking in a Company VehicleWritten Warning - Other than listed aboveViolation of Cardholder AgreementReason for Warning Purchase of items for personal use Use of the credit card for cash advances Use of the credit card for any purchases other than fuel, unless authorized by management Failure to return the credit card when an employee is reassigned, terminated or upon request Failure to turn in receipts or other back up documentation to the Windstar Lines, Inc. with daily trip packets for the purpose of establishing accountable reconciliation procedures Any other usage or actions deemed detrimental to Windstar Lines, Inc Details of actions that warrented this warning:The following corrective action will be taken:Hours of Service ViolationSelect which HOS rule was violated (select all that apply) 10-hour 15-hour 70-hour Log Falsification Date of the Hours of Service Violation Medical Certificate SubmissionDate medical was obtained Date medical was turned in to Windstar Lines Preventable AccidentMost Recent Accident Date Number of Total Preventable AccidentsAccident Point TotalSamsara Safety Score Improvement PlanSamsara Safety Score - past 7 daysSamsara Safety Score - past 30 daysSamsara Safety Score - past 90 daysActions contributing to your low Samsara score Speeding Crash Distracted Driving Collision Risk Harsh Driving Traffic Signs and Signals Policy Violations Check all that applyHand-Held Mobile Device EventCell Phone Event Date First or Second Occurrence? First Occurrence Second Occurence Failing to Report Moving ViolationMoving Violation Conviction Date Moving Violation DescriptionSmoking in a Company VehicleDate of Offense Bus Number:Warning - OtherDetails of the Occurence (include description of impact on Company):Expected Improvement (include a clear statement as to the consequences of failing to improve):Employee Comments:Manager Comments:
