Disciplinary Action Form printable pdf download

Disciplinary Action Form

Employer: __________________________________________ Date: ________________________________

Employee Name: _____________________________________ SS#: _________________________________

Discipline Taken

Prior Dates of Discipline

□

Verbal Warning

_________ Verbal Warning

□

1st Written Warning

_________ 1st Written Warning

□

_________ 2nd Written Warning

2nd Written Warning

□

Suspension Pending Discharge

_________ Suspension Pending Discharge

Occurrences Resulting in Present Discipline

____________________________________________________________________________________________

Action Plan to Prevent Reoccurrences

____________________________________________________________________________________________

Employee* Signature: _____________________________________

Date: _________________

Supervisor Signature: ____________________________________

Date: _________________

Witness Signature : _____________________________________

Date: _________________

*If the employee refuses to sign this document, Manager needs to write on the above line that the Employee refused to sign.

Also, make a copy for the disciplined Employee that includes signatures.

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Disciplinary Action Form