Employee Discipline Form printable pdf download

Employee Discipline Form

Employee’s Name:__________________________________________

Job Title:__________________________________________________

What action will be taken against the employee?

Description of Incident:

 Poor Attitude

 Poor Performance

 Improper Behavior

 Late/Tardy: by how much?

 Yes  No

Has the impropriety of the employee’s actions been explained to the employee?

 Absence

 Other:

 Yes

 No

Did the employee offer any explanation for the conduct?

Details:

- If so, what was it?

Recommended Improvements:

Date & Time of Incident:_______________________________

Consequences of future violations:

Location of Incident:__________________________________

Name of Officer preparing report:_________________________________________________

Witnesses to Incident:________________________________

Signature of Officer____________________________________________________________

 Yes

 No

Was this incident in violation of a co. policy?

- If yes, specify which policy and how it was violated:

(Employee) My signature indicates I have received and understand this disciplinary action.

Employee Signature:______________________________________ Date__________

Employee Discipline Form