Name: | Dept: | Date: |
Date of occurrence: | Time: | Location: |
ACTION TAKEN:
□ Coaching | □ Verbal warning | □ Written warning |
□ Suspension_____day(s) | □ Termination | □ Other: |
(Depending on the nature of the offense, [Company Name] reserves the right to skip any steps at its discretion.)
DESCRIPTION OF ISSUE:
□ Absenteeism | □ Conduct | □ Safety violation |
□ Policy and/or procedure violation | □ Unsatisfactory job performance | □ Other: |
EXPLANATION:
GOALS/CORRECTIVE BEHAVIOR:
Should your record continue to be unacceptable in the above area(s), the company will find it necessary to take the following disciplinary action (or more depending on the situation):
□ Written warning | □ Suspension _____day(s) |
□ Termination | □ Other: |
EMPLOYEE COMMENTS:
You are formally being warned to bring to your attention the severity of this situation. Failure to correct this behavior and/or further violation of company policy will result in additional disciplinary action up to and including discharge. By signing below you acknowledge that you have received this notice.
Employee: __________________________________________________ | Date: __________ |
Supervisor: __________________________________________________ | Date: __________ |
HR Manager: ________________________________________________ | Date: __________ |
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