Progressive Discipline Form
Print Form
Kalamazoo Regional Educational Service Agency
Progressive Disciplinary / Reprimand Form
Employee Name: ________________________________ Date: ____________________
Title: _____________ Location:_________________ Supervisor: ____________________
Hire Date: ______________________ Within Probationary Period?
YES
NO
Describe Nature of Incident(s):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Disciplinary Step
_____
_____
_____
_____
_____
First Discussion
Verbal Warning
(Requires Consultation with Human Resources)
Written Warning
Final Warning with Possible Suspension
Termination of Employment According to Employment Status
Action Plan for Improvement:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Employee¡¯s Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Employee¡¯s signature indicates that this matter was discussed with him/her. It does not indicate agreement.
Employee¡¯s Signature:_____________________________ Date__________
Supervisor¡¯s Signature:_____________________________ Date__________
Copy sent to Human Resources
All written reprimands are to be forwarded to Human Resources within 24 hours of occurrence.
This policy does not negate or modify the at-will employment status of part time or part time temporary employees.
Progressive Discipline Form.doc
S:\Personel\HR Files\Forms & Labels & Logo\Progressive Discipline Form.doc
Discriptives:
Irregular attendance
Excessive absenteeism
Excessive lateness/tardiness
Excessive lateness reporting back from lunch break
Improper call in procedures
Failure to report absence
No show, no call
Failure to follow instructions
Substandard quality and/or quantity of work
Unauthorized eating
Possession or use of drugs (including smoking) or alcoholic beverages on company premise or time.
Working after use of drugs or alcohol
Failure to complete tasks promptly and accurately
Horseplay
Inappropriate behavior within student range
Immorality
Failure to report safety hazard
Acting unsafely
Failure to report injury or accident
Unauthorized use of company property
Improper language
Unauthorized solicitation
Loafing
Falsifying company records or information
Theft of company property
Dishonesty concerning company matters
Insubordination
Fighting or conduct of intimidation
Arrest and conviction of serious criminal offense
Disclosure of confidential company information
Disrespect shown to others
S:\Personel\HR Files\Forms & Labels & Logo\Progressive Discipline Form.doc
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