ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
EMPLOYEE INFORMATION
2
Employee’s Full Name
3
Position
4
Department
5
Supervisor/ Manager
6
Employee ID
7
Contact Phone Number:
8
Alternate Phone Number
9
Contact Address
10
11
INFRACTION INFORMATION
12
Date of Infraction
13
Description of Infraction
14
Witnesses
15
16
DISCIPLINARY ACTION TAKEN
17
Date of Disciplinary Action
18
Type of Disciplinary Action
19
Description of Disciplinary Action
20
Signatures of Employee and Manager
21
22
ACKNOWLEDGMENT OF DISCIPLINARY ACTION:
23
[Employee Signature]:
24
[Date]:
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100