Disciplinary Write-Up Form

Employee Disciplinary Write-up Form
Reporting Date*

MonthDayYear
Date
Employee Name*

First NameLast Name
Employee Classification/Position*
Discipline Taken*

Verbal WarningWritten WarningSuspensionOther
Supervisor completing this form*

Eric OdonelCarolina AlmendarezChris PettisCody ZimmermanKris GardnerJoe PerezJosh DiGulioPaul SchaiderZach McCoyMichael KovalJoey BuddSean McCabeCindy GillenSean SesherOther
If "Other" please provide email:
example@example.com
Violations

Violations are classified according to their seriousness.
Group A Violations:

Theft or other acts of dishonesty.Immoral or indecent conduct.Falsification of any Company record.Insubordination or flagrant disobedience.Drinking or possession of alcohol or unprescribed drugs during working hours.Assault, threat, or coercion in any connection with Company business.Willful destruction or damage to Company property.Commission of any felony.Disclosing confidential information without authorization.Violation of safety measures endangering life, safety or health of others.
Group B Violations:

Negligence or carelessness resulting in damage to Company property.Failure to use proper fall protection.Not following hot work procedures, P.P.E. and work permits.Not following excavation procedures, access and egress, cave in protection.No locate for underground utilities when digging.Not following lock out tag out procedures.Not following confined space procedures.Rigging violations, slings, chains, overloading or not using proper equipment. Working with damaged lifting equipment.Blatant misuse of laddersAbusive conduct or discourtesy toward customers, employees, or others.Reporting to work intoxicated, under the influence of drugs, drug test failure or refusal to take drug test.Failure to follow company policy or procedures.Failure to follow directions from supervisor.Dangerous or careless driving (i.e. excessive speeding, harsh driving, failure to properly secure loads, reasonably preventable accidents, etc.).
Group C Violations:

Misuse of time during working hours.Failure to conform to work scheduleSpecific acts of inefficiency or carelessnessSmoking in unauthorized areas on Company property or customer’s properties.P.P.E. violations, hard hat, safety glasses, gloves, reflective vests etc.Failure of inspections, daily walk around on vehicles and equipment. Equipment, vehicle and tool violations. Not reporting tool or equipment deficiencies.Failure to wear seatbelts in company vehicles, or not using seat belts on equipment that requires their use.Unexcused absence.Excessive absenteeism or tardiness, regardless of cause.Leaving work without permission.Lack of insurability.Malicious gossip or derogatory attacks on the Company or fellow employees.Failure to adequately supervise subordinates.Failure to adequately communicate and enforce company policies to subordinates.Failure to adequately digest and distribute company communications to subordinates.Failure to adequately and reasonably plan ahead.Failure to attend safety meetings.
Other violation:
Further details:
Disciplinary Actions
Disciplinary Action Taken:*

VerbalWritten warningTwo day (20 hour) suspensionDischarge/TerminationOther
Further disciplinary actions or details:
Corrective Actions
What can be done to correct/prevent this issue going forward:*
Signatures

Signatures must be clear and easily recognized as the employees signature.
BY SIGNING THIS DISCIPLINARY FORM, THE EMPLOYEE MERELY ACKNOWLEDGES THAT HE OR SHE HAS READ IT, NOT THAT HE OR SHE AGREES WITH ITS CONTENTS.
Employee Comments
If the employee disagrees with this write-up or would like to add further details, please add those details here.
If this form submission is only intended to document at vebal warning, the employee's signature is not necessary. Please just write "N/A" in the signarture field.
Employee Signature*

Clear
Employee Name*

First NameLast Name
Manager/Supervisor Signature*

Clear
Manager/Supervisor Name*

First NameLast Name
Should be Empty:

Employee Disciplinary Write-up Form

Violations

Disciplinary Actions

Corrective Actions

Signatures