Fillable Employee Disciplinary Action Form printable pdf download

Employee Disciplinary Action Form

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CITY OF HAINES CITY

EMPLOYEE DISCIPLINARY ACTION FORM

EMPLOYEE NAME:

DEPARTMENT:

JOB TITLE:

SUPERVISOR:

DATE OF INCIDENT:

TIME OF INCIDENT:

NATURE OF INCIDENT

MISCONDUCT ON THE JOB

MISCONDUCT OFF THE JOB

INEFFICIENCY

EXPLAIN SPECIFIC INCIDENT:

(ADD PAGE IF NECESSARY)

PLAN FOR IMPROVEMENT:

(ADD PAGE IF NECESSARY)

CONSEQUENCES OF

FURTHER INCIDENTS:

(ADD PAGE IF NECESSARY)

DISCIPLINARY ACTION TAKEN

VERBAL WARNING:

SUSPENSION:

ADMINISTRATIVE LEAVE:

RECOMMENDATION

FOR TERMINATION:

WRITTEN WARNING:

(See attached Memo)

EMPLOYEE'S ACKNOWLEDGEMENT OF RECEIPT

By signing this form you confirm that you understand the information in this warning. You also confirm that you and your manager have

discussed the warning and a plan for improvement. Signing this form does not necessarily indicate that you agree with this warning . ANY

ADDITIONAL VIOLATIONS MAY RESULT IN FURTHER DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION.

EMPLOYEE SIGNATURE

DATE

HUMAN RESOURCES SIGNATURE

DATE

SUPERVISOR SIGNATURE

DATE

DEPARTMENT HEAD SIGNATURE

DATE

White- Personnel File

Yellow- Department Copy

Pink - Employee Copy

Employee Disciplinary Action Form

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