Town Of Duxbury Verbal Warning Form Page 8
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10Town of Duxbury
WRITTEN WARNING FORM
Employee Name ___________________________________ Date _______
Supervisor:_______________________
Department: __________________________
Subject:____________________
This is official notice of disciplinary action. The purpose of this written warning is to bring to
your attention ongoing deficiencies in your conduct and/or performance. The intent is to define
for you the seriousness of the situation so that you may take immediate corrective action.
This written warning will be placed in your personnel file and shall serve as notice of progressive
discipline in accordance with the town’s progressive discipline policy. If you have further
questions concerning this, please review them with me.
The reason for this action
_________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Summary of corrective plan of action _________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Follow up date(s) _______________
_______________
The above has been discussed with me by my supervisor. I understand the contents and
acknowledge and understand the corrective action required. I also acknowledge and understand
the potential consequences of non-compliance. I have read this written notice of disciplinary
action, but do not necessarily agree with its content
EMPLOYEE _________________________
DATE __________________
SUPERVISOR ________________________
DATE __________________
DEPT. HEAD_________________________
DATE __________________
cc: Employee File
Page 8
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