Disciplinary Action Form
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1DISCIPLINARY ACTION FORM
EMPLOYEE NAME:
____________________________
DEPARTMENT:
____________________________
SUPERVISOR:
____________________________
DATE:
____________________________
_________________________________________________________________________________________________
Please check one:
VERBAL WARNING:
NO DISCIPLINARY ACTION TAKEN
VERBAL WARNING:
DISCIPLINARY ACTION TAKEN (SEE BELOW)
WRITTEN WARNING:
NO DISCIPLINARY ACTION TAKEN
WRITTEN WARNING:
DISCIPLINARY ACTION TAKEN (SEE BELOW)
FINAL WARNING:
TERMINATION PAPERS ATTACHED
DETAILS OF INFRACTION:
_______________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
DISCIPLINARY ACTION TAKEN:
________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
EMPLOYEE’S COMMENTS:
_______________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
EMPLOYEE:
______________________________
SUPERVISOR: ________________________________
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