Written Notice Page 2
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2Form 129-01-004 (Revised 08/14/12)
WRITTEN NOTICE OFFENSE CODES
01
Attendance/excessive tardiness
02
Leaving work without permission
03
Failure to report without notice
04
3 days absent without authorization
11
Unsatisfactory Performance
12
Uniform violation/personal grooming
13
Failure to follow instructions and/or policy
14
Safety rule violation
31
Violation of Policy 1.05, Alcohol and Other Drugs
32
Violation of Policy 1.80, Workplace Violence
33
Violation of Policy 2.05, Equal Employment Opportunity
34
Violation of Policy 2.30, Workplace Harassment
35
Abuse of state time
36
Obscene or abusive language
37
Disruptive behavior
38
Conviction of moving traffic violation while using a state vehicle
51
Unauthorized use of State property or records
52
Computer/Internet misuse
53
Failure to report misdemeanor (if required)
54
HIPAA violation
55
Fraternization with patient/inmate/client
56
Insubordination
57
Refusal to work overtime as required
71
Sleeping during work hours
72
Theft
73
Threats or Coercion
74
Falsifying records
75
Gambling
76
Criminal conviction
77
Damaging state property or records
78
Interference with state operations
79
Unlawful weapons possession
81
Patient/inmate/client abuse
99
Other (describe)
Employee receives original, department and HR receive copies
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