Fillable Printable Disciplinary Action Form

Disciplinary Action Form

DISCIPLINARY ACTION FORM

EMPLOYEE:_______________________________POSITION:__________________________

SUPERVISIOR:_______________________________DEPARTMENT:___________________

TYPE OF ACTION:

Verbal Counseling (Dept File Only)

Written Warning

Suspension: From__________________To:_________________________

Termination: Effective _______________

Date(s) of Incident_________________________________Time of Incident:_______________

Type of Incident: Description:

______________________________________________________________________________

Corrective Action Plan:

______________________________________________________________________________

Next Action Step If Problem Continues:

______________________________________________________________________________

I acknowledge receipt of this disciplinary action and that its contents have been discussed with

me. I understand that my signature does not necessarily indicate agreement.

___________________________________ ________________________

Employee Signature Date

___________________________________ ________________________

Manager/Supervisor Signature Date

___________________________________ ________________________

Human Resources Representative Date

Original: Human Resources Yellow: Department Pink: Employee

HCG-