EMPLOYEE DISCIPLINARY ACTION FORM
EMPLOYEE DISCIPLINARY ACTION FORM
Employee:
Date of Warning:
Department:
Supervisor:
TYPE OF VIOLATION:
WARNING:
Attendance
Carelessness
Safety
Tardiness
Disobedience
Work Quality
Other
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
Title
I have read this "warning decision". I understand it
and have received a copy of the same.
1st Warning
Date
Verbal
Employee Signature
Date
Signature of person who prepared warning
Date
Supervisor's Signature
Date
Written
Previous Warning:
2nd Warning
Date
Verbal
Written
Previous Warning:
3rd Warning
Date
Verbal
Written
Employee
COPY DISTRIBUTION
HR Dept
Supervisor
................
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