University of Houston-Victoria
Formal Written Reprimand
A. Summarize the reason for the written reprimand: the policy, procedure or rule that has been
violated or the standard to be met.
B. Cite any previous counseling including date(s), number of infractions and dates of occurrences and
disciplinary measures, if any.
C. State the problems that have resulted from the failure to perform or meet standards.
D. State the consequence of failure to correct the behavior.
EMPLOYEE ACKNOWLEDGEMENT: I acknowledge receipt of this written reprimand but not necessarily
agreement with its content. I understand that a copy of this formal reprimand will be placed in my official
personnel file and that I have the right to prepare a letter of rebuttal to be attached to the written reprimand.
I understand I also have the right to appeal this action