LO S ANG E LE S CO MMUNI TY CO LLE G E DI S TRI CT

DEPARTMENT OF FACILITIES PLANNING AND DEVELOPMENT

SUSTAINABLE BUILDING PROGRAM

NOTICE OF SAFETY NON-COMPLIANCE

To:                               , Contractor Representative

From:                               , College Project Director

Your company has been found to be in non-compliance with one or more safety requirements applicable to
the Project, as specified below. These non-compliances with safety requirements must be corrected
immediately.

Item of Non-Compliance
Item #      
                    

Item of Non-Compliance
Item #      
                    

Item of Non-Compliance
Item #      
                    

Item of Non-Compliance
Item #      
                    

Item of Non-Compliance
Item #      
                    

Issued By:            

COLLEGE PROJECT DIRECTOR
PRINT NAME DATE
(PLEASE SIGN)

Received By:            

CONTRACTOR REPRESENTATIVE PRINT NAME DATE
(PLEASE SIGN)

cc: LACCD-BUILD Program Safety Manager

CPS-0405 Page 1 of 1 Revised

03/16/2015