Employee Disciplinary Action Form
Employee Disciplinary Action Form
Employee Disciplinary Action Form
Employee Information
Name of Employee:__________________________________________________________
Employees Job Title: ________________________________________________________
Incident Information
Date/Time of Incident:________________________________________________________
Location of Incident:_________________________________________________________
Description of Incident:_______________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Witnesses to Incident:________________________________________________________
Was this incident in violation of a company policy?
Yes
No
If yes, specify which policy and how the incident violated it. ___________________________
____________________________________________________________________
____________________________________________________________________
Action Taken
What action will be taken against the employee?____________________________________
____________________________________________________________________
____________________________________________________________________
Has the impropriety of the employees actions been explained to the employee? Yes
No
Did the employee offer any explanation for the conduct? If so, what was it? ______________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Signature of person preparing report:____________________________________________
Date: __________________________________________________