An Employee Disciplinary Action Form in PDF format with the following content:

EMPLOYEE DISCIPLINARY ACTION FORM

Employee: Department:

TYPE OF VIOLATION:

Date of Warning: Supervisor:

WARNING:

Violation Date:

Violation Time: (a.m. / p.m.) Place Violation Occurred:

Attendance Safety Other

Carelessness Tardiness

Disobedience Work Quality

EMPLOYER STATEMENT

EMPLOYEE STATEMENT

Approved by:

WARNING DECISION

Name Title Date

List All Previous Warnings (when warned and by whom):

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

Previous Warning: Date Verbal Written

Previous Warning: Date Verbal Written

Previous Warning: Date Verbal Written

1st Warning

2nd Warning

3rd Warning