Record Of Disciplinary Action

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Record of Disciplinary Action
Employee Name: __________________________________
Employee Title: ___________________________________
Manager’s Name: _________________________________
Manager’s Title: _________________________________
Today’s Date: ____/____/______
Incident Date: ____/____/______
Incident Time: ____:____
Incident Location: ______________________________________________________________
Description of Incident: __________________________________________________________
Witnesses to the Incident: ________________________________________________________
Names of those in attendance at the Disciplinary Action Meeting:
______________________________________________________________________________
The Disciplinary Action that will be carried out:
______________________________________________________________________________
If probation is given:
Start Date: ____/____/_____
End Date: ____/____/_____
Goals to Be Achieved Through this Disciplinary Action:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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