Disciplinary Action Report Please Fill out This Form: Staff Name * Staff Name First Name First Name Last Name Last Name Email * Phone Number * Date of Occurrence * Action details: * plus1 Add minus1 RemoveDisciplinary Action * Tardiness Absenteeism Dress Code Safety Insubordination Substance Abuse Work Performance Policy Violation Other Details of Occurrence * Has this or a similar infraction occurred before? No YesRepeater Occurrence Date Action Taken plus1 Add minus1 RemoveCorrective action to be taken * Verbal Counseling Written Warning Disciplinary Suspension Final Warning Counseling with Human Resources Termination Date Termination Date Consequence for unsatisfactory improvement and/or further disciplinary actions Verbal Counseling Written Warning Disciplinary Suspension Final Warning TerminationEmployee Statement:I acknowledge by my signature below that I have been given the opportunity to present my views and explanations and I am signing this review prior to it being placed in my personnel file. I also understand the corrective actions to be taken by my supervisor and consequences if my improvement is unsatisfactory or 1 receive further disciplinary actions. Date * Employee Name * Employee Signature * signature keyboard Clear Supervisor Contact Date * Supervisor Name * Supervisor Signature * signature keyboard Clear Captcha Submit If you are human, leave this field blank.
