Employee Disciplinary Action Form
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1EMPLOYEE DISCIPLINARY ACTION FORM
Employee:
Date of Warning:
Department:
Supervisor:
TYPE OF VIOLATION:
WARNING:
Carelessness
Violation Date:
Attendance
Disobedience
Violation Time: (a.m. / p.m.)
Safety
Tardiness
Work Quality
Place Violation Occurred:
Other
EMPLOYER STATEMENT
EMPLOYEE STATEMENT
WARNING DECISION
Approved by:
Name
Title
Date
I have read this "warning decision". I understand it
List All Previous Warnings (when warned and by whom):
and have received a copy of the same.
Previous Warning:
1st Warning
Date
Verbal
Employee Signature
Date
Written
Previous Warning:
2nd Warning
Date
Signature of person who prepared warning
Date
Verbal
Written
Previous Warning:
3rd Warning
Supervisor's Signature
Date
Date
COPY DISTRIBUTION
Verbal
Employee
HR Dept
Supervisor
Written
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Parent category: Business