Fillable Employee Disciplinary Action Form

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Employee Disciplinary Action Form

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The Employee Disciplinary Action Form form is 2 pages long and contains:

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  • 13 check-boxes
  • 31 other fields

Country of origin: OTHERS
File type: PDF

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EMPLOYEE DISCIPLINARY ACTION FORM
Employee: ________________________ Date of Warning: ________________________
Department: _______________________ Supervisor: ________________________
________________________________
Type of Violation
❏ - Attendance ❏ - Carelessness ❏ - Disobedience ❏ - Safety ❏ - Tardiness
❏ - Work Quality ❏- Other (explain) _______________________________________________
________________________________
Warning
Violation Date: ________________________ Violation Time: ________________________
Violation Location: ________________________________________________
________________________________
Employer’s Statement
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
________________________________
Employee’s Statement
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
________________________________
Decision
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Decision Approved by: _________________ Title: _________________ Date: _____________
________________________________
Previous Warnings
1
st
Warning - Date: _________________ Type: ❏ - Verbal ❏ - Written
2
nd
Warning - Date: _________________ Type: ❏ - Verbal ❏ - Written
3
rd
Warning - Date: _________________ Type: ❏ - Verbal ❏ - Written
________________________________
Signatures
Employer’s/Supervisor’s Signature: ___________________________ Date: _______________
Print Name: ___________________________ Title: ___________________________
I have read this "warning decision". I understand it and have received a copy of the same.
Employee’s Signature: ___________________________ Date: _______________
Print Name: ___________________________ Title: ___________________________
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Employee Disciplinary Action Form

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Completed 26 January 2022

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