EMPLOYEE DISCIPLINARY ACTION FORM
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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