Fillable Printable Record Of Infraction General Services Administration
Fillable Printable Record Of Infraction General Services Administration
Record Of Infraction General Services Administration
RECORD OF INFRACTION
See
INSTRUCTIONS
on reverse
GRADE
DATE
DATE
DATE
HIGHER LEVEL
SUPERVISOR (Signature)
DATE
TITLE
LOCATION
TITLE
TITLE
TITLE
NAME OF EMPLOYEE
ORGANIZATION
1. SUPERVISOR'S REPORT
SUPERVISOR
(Signature)
EMPLOYEE
(Signature)
3. PREVIOUS INFRACTIONS (Nature of offense, penalty action taken, and date of penalty action)
4. ACTION TAKEN OR RECOMMENDED (Give reasons for any deviations from Penalty Guide)
5. ACTION TAKEN OR RECOMMENDED (Include any appropriate comments)
SUPERVISOR
(Signature)
2. EMPLOYEE'S STATEMENT -- I HAVE READ THE ABOVE REPORT AND MAKE THE FOLLOWING COMMENT:
GENERAL SERVICES ADMINISTRATION
GSA FORM 225 (6-62)
INSTRUCTIONS
The immediate supervisor is normally the one responsible for initiating corrective action when an
employee under his supervisor violates regulations or GSA Standards of Conduct. This form is for use
in reporting violations under Table I of the Penalty Guide, according to the instructions in the GSA
Administrative Manual 3-111.
The supervisor should make a thorough and careful inquiry into the facts, interviewing the employee
and any witnesses who have firsthand information. He should make every effort to reconcile conflicting
statements and to get the whole story before filing out this form and making any judgment.
WHAT TO REPORT -State the facts simply and in logical order. All persons, places,
dates and records referred to should be fully identified. If more space is required, attach
a sheet of paper to the form.
2.GETTING THE EMPLOYEE'S STATEMENT -The supervisor should ask the employee
to read the report in block 1 and furnish his comments and signature. The employee may
admit, deny, or explain the alleged infraction. If he admits the offense as reported,
statement of witnesses need not be obtained. If witnesses' statements are secured, they
should be attached to this form.
3.RECORDING PREVIOUS INFRACTIONS -The employee's previous record will be used
in applying the Penalty Guide and in considering any deviation from the Guide. Only
those Table I offenses for which penalty action was imposed within the last three years
will listed. Table II offenses will be listed without regard to the date they occurred.
5.ACTION BY HIGHER LEVEL SUPERVISOR -This block is provided for action by a
higher level supervisor, as needed. The instructions in 4, above, also apply here. If an
adverse personnel action is believed warranted, i.e., suspension, demotion, or removal,
the form will be forwarded to the Personnel Division for action.
6.NOTIFICATION TO EMPLOYEE -The employee must be advised of the final decision
with respect to any infraction written up on this form.
4.ACTION BY THE SUPERVISOR -The supervisor who fills out this block may be the
same one who filled out the report in block 1, or may be a supervisor at a higher level. He
should consult the Penalty Guide and carefully weigh all the facts revealed by the inquiry,
as well as the employee's statement in block 2. If he decides that no penalty action is
warranted, he will so advise the employee and destroy this form. If he decides on either a
warning notice or an official reprimand and is authorized to take such penalty action, he
should note the fact in this block and issue the appropriate notice to the employee. A
copy of the notice to the employee, together with the original of this form and any
additional statement of comment or explanation received from the employee within 10
days, will be forwarded to the Personnel Division for the employee's official personnel
folder. If the supervisor decides on a penalty action which he is not authorized to take, he
will make his recommendation in the block and forward the form through channels for
action.
1.
GSA FORM 225 (6-62) BACK
