Disciplinary Action Form - Sheakley printable pdf download

Disciplinary Action Form - Sheakley

Disciplinary Action Form

Employee Information:

Name:

Date of Written Warning:

Supervisor Name:

Date of Infraction:

Reason for Disciplinary Action:

Policy Violation

Safety Violation

Personal Conduct

Work Performance

Attendance/Tardy

Other:

Description of issues resulting in disciplinary action (indicate relevant company policies and rules and

previous discipline for same offense):

Disciplinary Action Taken:

First Written Warning

Second Written Warning

Third Written Warning

Final

Written Warning

Suspension, # of Days: _______ Beginning: _____________ Ending: ____________

Termination of Employment

Requirements employee must meet and consequences of not meeting them:

Any further disciplinary issues or violations of company policies/procedures will result in additional

disciplinary action up to and including termination.

Employee Comments:

Employee’s Signature:

Date:

Note: Employee's signature shows only that the employee has seen this document and not that he/she is necessarily in

agreement.

Supervisor’s Signature:

Date:

Disciplinary Action Form - Sheakley