DISCIPLINARY REPORT / WARNING FORM

NAME OF EMPLOYEE: _____________________________
 
POSITION/JOB TITLE: _____________________________
 
IMMEDIATE SUPERVISOR: _____________________________
 
 
ACTION TAKEN:
 
____ FIRST WRITTEN WARNING
 
____ SECOND WRITTEN WARNING
 
 
 
EFFECTIVE PERIOD: _________ (MONTHS)
 
REASONS FOR WARNING / BRIEF ACCOUNT OF INCIDENT
 
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EXPLANATION OF THE EMPLOYEE
 
 
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RECOMMENDED FUTURE CONDUCT AND / OR CORRECTIVE ACTION
REQUIRED OF EMPLOYEE/SUPERVISOR
 
 
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It is noted that further misconduct may result in more serious disciplinary action.
 
 
 
Above action was taken by: ________________________________________
 
 
 
 
Employee represented by: __________________________________________
 
SIGNATURE: ______________________________
 
DATE: ____________________________________
 
 
I HEREBY ACKNOWLEDGE RECEIPT OF THE WARNING AND UNDERSTAND THE CONTENTS THEREOF.
 
SIGNATURE: ______________________________
 
DATE: ____________________________________
 
 
 
Copy: Employee, Personnel File
Located in: All Policies