Employee Disciplinary Action Form

Information you will need

• What’s the name of the employee's supervisor?
• What's the date?
• What’s the employee's department?
• What’s the employee's title?
• What's the employee's work ID number?
• Is the disciplinary action due to attendance issues?
• Is the disciplinary action due to tardiness?
• Is the disciplinary action due to harassment?
• Is the disciplinary action due to disobedience?
• Is the disciplinary action due to performance issues?
• Is the disciplinary action due to theft or damage?
• Is the disciplinary action due to safety issues?
• Is the disciplinary action due to conduct issues?
• Is the disciplinary action due to a reason not listed here?
• What’s the other reason for disciplinary action?
• When did the issue/violation happen?
• On what date was the first warning issued? (if applicable)
• On what date was the second warning issued? (if applicable)
• Was the first warning written or verbal?
• On what date was the third warning issued? (if applicable)
• Was the second warning written or verbal?
• Was the third warning written or verbal?
• What’s the employee’s statement regarding the above mentioned issue/violation?
• What disciplinary action will be taken?

…and 5 more fields in the PDF.

Completed by the employee.

The form includes a witness section.