Town Of Duxbury Verbal Warning Form Page 7
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10Town of Duxbury
VERBAL WARNING FORM
Employee Name ___________________________________ Date _______
The following warning has taken place:
(Check and give details under explanation)
[ ] Harassment
[ ] Absence
[ ] Dishonesty
[ ] Tardiness
[ ] Violation of safety rules
[ ] Violation of Company Policy
[ ] Leaving work without authorization
[ ] Horseplay
[ ] Poor performance
[ ] Smoking in unauthorized areas
[ ] Insubordination
[ ] Failure to follow instructions
[ ] Falsification of records
[ ] Unauthorized use of equipment, materials
[ ] Other
Summary of violation _____________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Summary of corrective plan of action __________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
FOLLOW UP DATE(S) _______________
_______________
SUPERVISOR
SIGNATURE
_________________________
DATE ________
EMPLOYEE
SIGNATURE
_________________________
DATE ________
cc: Employee File
Page 7
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