Employee Disciplinary Notice - Sample Form

DISCIPLINARY NOTICE

 

 

Employee Name:                                                               Department:                                             

 

Written Warning                Final Warning  

 

1.	Statement of the problem (violation of rules, policies, standards, practices or unsatisfactory performance):
2.	Prior discussion or warnings on this subject (oral, written, dates):
3.	Statement of company policy if any on this subject:
4.	Summary of corrective action to be taken (include dates for improvement and plans for follow-up):
5.	Consequences of failure to improve performance or correct behavior:
6.	Employee comments:
	The above has been discussed with me by my supervisor. I understand the contents and acknowledge and understand the corrective action required. I also acknowledge and understand the potential consequences of non-compliance.

 

Employee Signature                    
Date                        

Supervisor’s Signature                
Date

 

 

 

Distribution:  One copy to Employee, one copy to Supervisor and original copy to Personnel File