EMPLOYEE DISCIPLINARY ACTION FORM

[Pages:1]EMPLOYEE DISCIPLINARY ACTION FORM

Employee: Department:

Date of Warning: Supervisor:

TYPE OF VIOLATION:

WARNING:

Attendance Safety Other

Carelessness

Tardiness

Disobedience Work Quality

Violation Date: Violation Time: (a.m. / p.m.) Place Violation Occurred:

EMPLOYER STATEMENT

EMPLOYEE STATEMENT

WARNING DECISION

Approved by:

Name

List All Previous Warnings (when warned and by whom):

Previous Warning: Date

Verbal Written Previous Warning:

Date Verbal Written Previous Warning:

Date Verbal Written

1st Warning 2nd Warning 3rd Warning

Title

Date

I have read this "warning decision". I understand it and have received a copy of the same.

Employee Signature

Date

Signature of person who prepared warning

Date

Supervisor's Signature

Date

COPY DISTRIBUTION

Employee

HR Dept

Supervisor

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