Disciplinary Action Form
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1Disciplinary Action Form
Report
Employee:
Violation No:
Reported to:
Date:
Reported by:
Date of Incident:
Report Type:
q Mail
q Email
q Phone
q In Person
Incident Details
Violation Type:
q Tardy/Absent q Insubordination q Unsatisfactory Work q Safety Violation
q Code of Conduct Violation q Drug Use q Other:
Location:
Witnesses:
Code Violations:
Incident:
Employee Statement
Corrective Action
q Written
q Verbal
q Probation
q Suspension with Pay
q Suspension without Pay
Suspension Start Date:
Suspension End Date:
Notice:
q First
q Second
q Third
q Final
Follow-Up
Improvement Goal:
Consequences:
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Parent category: Business