Record Of Conversation

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Record of Conversation
On this date ___\___\_____ I spoke with ____________________________________,
who is a ___________________________ in the
___________________________________________ Department about the following.
Reason for Conversation:
Description of Violation:
Describe the Investigation and Results:
Action Taken:
Coaching
Written Warning
Suspension, # of Days: _______ Beginning: __________
Ending: ________
Termination of Employment
Employee Comments:
NOTE: Failure to correct the behavior leading listed in this Record of Conversation and/or further
violation of company policy will result in additional disciplinary action, up to and including
termination of employment. By signing below, you acknowledge that you have received this notice.
Employee’s Signature:
Date:
Supervisor’s Signature:
Date:

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