Reprimand Form - Washoe County School District Human Resources
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1APPENDIX C.2
WASHOE COUNTY SCHOOL DISTRICT
Human Resources
LEVEL TWO: REPRIMAND FORM
1. Employee Name: _____________________________________ Employment Date: _________________________________
Title: _____________________________________________ Location: __________________________________________
2. This notice is to bring to your attention a problem in the following area(s):
Work Performance
Dishonesty
Conduct
Physical/Mental Incapacity
Insubordination
Discourtesy
Alcohol/Drugs
Misuse/Destruction of WCSD Property
Theft
Criminal Conviction
Absenteeism/Tardiness
Other: __________________________________________________________________________
3. Occurrence Detail: _______ _______ _______
_______ a.m.
_______ p.m.
Month
Day
Year
Time
Time
4. Previous Warnings:
Informal Counseling
Warning Notice
Reprimand
(Date(s)
______________________
___________________
_____________________
______________________
___________________
_____________________
______________________
___________________
_____________________
5. Explanation of Problem(s):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
The problem(s) described above is serious and is the cause for this disciplinary notice. In addition, if you have been warned previously,
it is noted above.
6. Improvement Needed: You are encouraged to think about this reprimand, resolve to change your behavior and/or improve your
performance. In order to avoid further disciplinary measures, it is recommended that you:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
If you do not improve, it will be necessary to consider stronger disciplinary measures, including suspension, demotion, and termination.
A copy of this reprimand will be placed in your personnel file. If you have any questions in this matter, or if you need assistance in
improving your performance, you are encouraged to contact me.
You have the right to respond in writing in order to present information or arguments rebutting this disciplinary measure. If you choose
to do so, your response will be attached to this form.
7. The employee’s signature below indicates only that the employee has received and read this document.
Employee Signature: ______________________________________________
Date: ___________________________
Supervisor’s Signature: _____________________________ Title: ________________________ Date: __________________
Administrator’s Signature: ___________________________ Title: ________________________ Date: __________________
cc:
Personnel File
______________________________
1/30/09, Rev. A
HR-F606
Page 1 of 1
Date: 1/30/09, Rev. A
HR-F606
Page 1 of 1
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