Uno Discipline Documentation Form-For Internal Use printable pdf download

UNO Discipline Documentation Form-For Internal Use

Employee Information

Name and Job Title of Employee:_________________________________________________

Incident Information

Date/Time of Incident: _________________________________________________________

Location of Incident: ___________________________________________________________

Description of Incident: _________________________________________________________

_____________________________________________________________________

____________________________________________________________________________

Witnesses to Incident: __________________________________________________________

Was this incident in violation of University policy, department procedure/policy? Yes___ No___

If yes, specify which policy/procedures and how the incident violated it.

_____________________________________________________________________

Action Proposed

What action is proposed to address the employee’s actions? ____________________________

_____________________________________________________________________

Has the impropriety of the employee’s actions been explained to the employee? Yes__ No__

Did the employee offer any explanation for the conduct? If yes, what was the explanation?

_____________________________________________________________________

Prior Incidents?

Date of prior incident(s) and summary of incident(s)___________________________________

____________________________________________________________________________

Action taken__________________________________________________________________

Printed name of person preparing report:_________________________________________

Date______________________ Signature_________________________________________

Uno Discipline Documentation Form-For Internal Use