Employee Reprimand Form
Employee
Employee Reprimand
Work Location
Date of Discipline Action Given
Employee ID # (if any)
Date of Occurrence
Issuing Supervisor
Violation Statement
Place of Violation: _______________________ Date of Violation: _______________________ Description of Violation: ____________________________________________________________
Disciplinary Action
- Administrative Leave w/Pay - Sent Home w/Pay - None
- Recommendation for Termination - Suspension Without Pay ___ Days - Other ____________________________
Corrective Actions
Description of Corrective Actions to be Taken: ________________________________________________________________________________ ________________________________________________________________________________
- I have read this Notice of Discipline and understand it.
____________________________ ____________________
________________
Employee's Signature
Print Name
Date
- Employee refused to sign this form and all attached documentation.
____________________________ ____________________
Supervisor's Signature
Print Name
________________ Date
................
................
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