Employee Write Up
Employee name
*
First Name
Last Name
Job tite:
*
Date
*
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Month
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Day
Year
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Time
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:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Supervisor submitting form
*
First Name
Last Name
Reason for write up
*
Failure to use application (HouseCall, LMN, etc)
Tardiness/Leaving work early
Substandard work
Absenteeism
Violation of safety rules
Violation of company policies
Failure to follow procedures
Rude behavior directed at Customers or Coworkers
Damaged, misuse, or poor treatment of equipment
Out of uniform
Other
Description of infraction
Cost of damage/incident
Concequences of this infraction
*
Verbal warning
Further unpaid training
1st write up
2nd write up
Unpaid day off
Possible delay of payroll / check
Suspension w/o pay (remainder of the week)
1 week suspension w/o pay
2 week suspension w/o pay
Termination
Plan for improvement
Concequences of further infractions
*
Further unpaid training
1st write up
2nd write up
Unpaid day off
Delayed checks
Suspension w/o pay (remainder of the week)
1 week suspension w/o pay
2 week suspension w/o pay
Termination
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