Employee Warning Notice
Employee Name
Date of Warning
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Payroll Number
Department
Shift
Type of Violations (Select All That Apply)
Attendance
Carelessness
Insubordination
Lateness or Early Quit
Failure to Follow Instructions
Violation of Safety Rules
Rudeness to Employees or Customers
Willful Damage to Material or Equipment
Working on Personal Matters
Unsatisfactory Work Quality
Violation of Company Policies or Procedures
Other
Previous Warnings
First Warning
Type of Warning
Oral
Written
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
By Whom
First Name
Last Name
Second Warning
Type of Warning
Oral
Written
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
By Whom
First Name
Last Name
Third Warning
Type of Warning
Oral
Written
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
By Whom
First Name
Last Name
Incident Details
Employer Statement
Date of Incident
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Incident
Employee Response
I agree with Employer's Statement
I disagree with Employer's description of violation for these reasons:
Employee Statement
EMPLOYEE SIGNATURE
Date of Incident
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Action Taken
Type a question
Warning
Probation
Suspension
Dismissal
Other
Consequence(s) Should Incident Occur Again
I Have Read this Employee Warning Notice and Understand It
SIGNATURE OF EMPLOYEE
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SIGNATURE OF SUPERVISOR WHO ISSUED WARNING
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Routing
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