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Form Disciplinary Action Record

This document records a disciplinary action taken against an employee. It documents the employee and manager names, date of incident, description of the incident, witnesses, attendees of the disciplinary meeting, the corrective action to be taken, goals for the employee to achieve, consequences for failure to improve, prior warnings, an employee statement, and signatures from the employee and supervisor.

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roswan
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78 views

Form Disciplinary Action Record

This document records a disciplinary action taken against an employee. It documents the employee and manager names, date of incident, description of the incident, witnesses, attendees of the disciplinary meeting, the corrective action to be taken, goals for the employee to achieve, consequences for failure to improve, prior warnings, an employee statement, and signatures from the employee and supervisor.

Uploaded by

roswan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Record of Disciplinary Action

Employee Name Employee Title


Manager Name Manager Title
Today’s Date Incident Date
Incident Time Incident Location

Description of the incident that occurred:


____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Witnesses to the incident (if applicable):


____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Names of those in attendance at current disciplinary action meeting:


____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Corrective or disciplinary action to be taken:


 Verbal  Written  Probation  Suspension  Other (explain below)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

(If on probation, period begins ___________________ and ends ___________________.)

Goals to be Achieved:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Consequences for failure to improve performance or correct behavior:


___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Prior discussions or warnings on this subject, whether oral or written:


____________________________________________________________________________________
____________________________________________________________________________________

Employee statement:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

I acknowledge that I have read and understand the above information and consequences.

_______________________________ ______________________
Employee Signature Date

_______________________________ ______________________
Supervisor Signature Date

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