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Discipline Documentation Form

Discipline Documentation Form You can ref 2 forms as follows: Discipline Documentation Form 1 1. Employee Information Name of Employee:_____...

Discipline Documentation Form

You can ref 2 forms as follows:

Discipline Documentation Form 1


1. Employee Information

Name of Employee:_______________________________________________

Employee’s Job Title: _____________________________________________

2. Incident Information

Date/Time of Incident:____________________________________________

Location of Incident:______________________________________________

Description of Incident:___________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Witnesses to Incident:____________________________________________

Was this incident in violation of a company policy? Yes No

If yes, specify which policy and how the incident violated it. ___________
______________________________________________________________
_______________________________________________________________

3. Action Taken

What action will be taken against the employee?_______________________
________________________________________________________________
________________________________________________________________

Has the impropriety of the employee’s actions been explained to the employee? Yes No

Did the employee offer any explanation for the conduct? If so, what was it?
________________________________________________________________
________________________________________________________________
________________________________________________________________

Signature of person preparing report:_________________________________

Date: __________________________________________________

Discipline Documentation Form 2


Employee Name:_____________________________Job Title:________________

Supervisor’s Name:___________________________Job Title:________________

Incident Information

Date/Time of Incident:_________________Location of Incident:_______________

Description of Incident: _______________________________________________
_________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
___________________________________________________________________

Witnesses to Incident (Obtain signed written statements as appropriate): ___________

Was this incident in violation of a company policy? ____Yes ____No

If yes, specify which policy and how the incident violated it. _____________________
____________________________________________________________________
____________________________________________________________________

Has employee violated this policy within last 12 months? (Check personnel file) ____Yes ____No

If yes, give date(s):______________________________________________________

Action Taken

Date of Meeting with Employee:_________________ ____ In Person ____ By Phone

Has the impropriety of the employee’s actions been explained to the employee? ____Yes ____No

What action will be taken against the employee? ____ Verbal Counseling ____ Written Warning
____ Suspension ____ Dismissal
Improvement Required of Employee:_______________________________________
____________________________________________________________________
____________________________________________________________________

These matters will be reviewed on _________(date) or upon next occurrence.

Additional incidents may result in further disciplinary action up to and including dismissal.

Employee Comments¬¬¬¬_______________________________________________
____________________________________________________________________

____________________________________________________________________
____________________________________________________________________
Supervisor’s Signature Date Employee’s Signature Date

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