Team Member Warning Form

Team Member Warning Form
Store Number -*
Region*
Email*
StoreEmail
example@example.com
Supervisor Email*
DOemail
example@example.com
Date of the Violation -*

MonthDayYear
Date
VerbalWrittenAction Plan
Team Member Name
Team Member Name:*

First NameLast Name
Team Member's Position
Nature of the Violation*
PULSE Employee Number*
Explanation of Other from above
Detailed description of the incident -
Expected Performance -
Previous Discipline
Disciplinary Action
After submitting Written Counsel - Final, please fill out a Team Mamber Change Form
Company Notice to the Team Member:
Further incidents of this nature will result in disciplinary action up to and including termination.
Team Member Signature

Clear
YesNo
Name of the manager submitting the warning
Manager signature

Clear
Name of the witness (if present)
Witness Signature

Clear
YesNo
Team Member Statement
File Upload - if needed:

Cancelof
Action Plan:
An action plan is used to set clear expectations with a Team Member, specifically related to job critical actions or behaviors. Please answer the following questions and provide details below. On an action plan, a timeline to resolve the behaviour or make right on the incident at hand is required, in addition to signatures from both parties acknowledging the timeline as well as the expected behavior.
Action Plan presented by -*

First NameLast Name
Please provide a detailed description of the incident or behavior -*
Timeline to complete the Action Plan:*

MonthDayYear
Date
Action Plan requirements:*
What are the steps that the Team Member needs to complete in order to get taken off of the action plan?
Action to be taken if not complete -*
Demotion from -*
To -*
I,First Name* Last Name*, have reviewed the above action plan with First Name* Last Name*, and I fully understand what is expected of me. As well as the consequences if this action plan is not completed by the agreed upon timeline.
Signature -*

Clear
Should be Empty:

Team Member Warning Form

Action Plan: