Employee Disciplinary Action Notice Form

Employee Disciplinary Action Notice Form

Supervisors - Please contact HR before completing this form to confirm the employee's current disciplinary status.
Supervisor Filling Out This Form

First NameLast Name
Employee Receiving Notice

First NameLast Name
Date of Warning

MonthDayYear
Date
Employee's Current Disciplinary Stage - Note: Confirm the correct stage of warning with HR before proceeding. Please elaborate if 'Other' was chosen.

Other
When was the employee's disciplinary meeting for the first warning held?

MonthDayYear
Date
Indicate all the behavior(s) or action(s) that prompted this disciplinary notice.
Details of Unsatisfactory Behavior/Actions
Please outline the corrective actions that must be taken immediately and maintained by the employee. Failure to comply may result in further disciplinary action, up to and including termination.
Date of Follow-Up Disciplinary Meeting

MonthDayYear
Date
Supervisors- Before concluding this form, you must review its contents with the employee. Ensure the employee understands the reason for the disciplinary notice and the corrective actions required. Sign below to acknowledge, then the employee must sign under the employee acknowledgement section.
Supervisor Signature
Employee Acknowledgement
This portion of the form is to be completed by the employee who is receiving this disciplinary notice. Please review the contents of this form carefully. Your signature below confirms that you have received and reviewed the contents of this notice. Signing does not necessarily indicate agreement, only that the form has been discussed with you.
Employee Email
example@example.com
Employee Signature
Should be Empty:

Employee Disciplinary Action Notice Form

Employee Acknowledgement