Free Disciplinary Action Form 25Free Disciplinary Action Form 25Free Disciplinary Action Form 25
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NOTICE OF DISCIPLINARY ACTION
EMPLOYEE NAME:

DATE OF NOTICE:

SUPERVISOR NAME:

JOB POSITION:

TYPE OF PROBLEM OR VIOLATION:
 Tardiness
 Quality of Work
 Safety
 Absenteeism
 Quantity of Work
Drug or Alcohol Abuse
 Insubordination
 Neatness
 Carelessness
 Other:
 Date of Occurrence:

DETAILS OF OCCURRENCE (Include description of impact on Company):

CORRECTIVE ACTION TO BE TAKEN:
Suspension:With PayWithout Pay

First Day:

Other:

Last Day:

EXPECTED IMPROVEMENT (Include a clear statement as to the consequences of failing to improve)

EMPLOYEE’S STATEMENT (Use additional paper if necessary)

By signing this notice, I am acknowledging that I have been counseled about my inappropriate conduct and
informed of consequences if improvements are not made.
Employee Signature:

Date:

© 2015 www.hrthatworks.com
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SUPERVISOR CHECKLIST FOR NOTICE OF DISCIPLINARY ACTION



Reviewed the Managing Poor Performance
Checklist.



Described problem in detail