Legal Employment & Labor Disciplinary Action Form
Complete this form in its entirety to document any disciplinary action taken against an employee for violating [Your Company Name] policies or procedures. Ensure all sections are filled out accurately and that both the employee and supervisor sign the form to acknowledge understanding and receipt.
EMPLOYEE INFORMATION
Employee Name: | |
Employee ID: | |
Department: | |
Position: | |
Date Hired: | |
Supervisor: | |
INCIDENT INFORMATION
Date of Incident: | |
Location of Incident: | |
Witnesses: | |
NATURE OF THE VIOLATION
Type of Violation: | ☐ Attendance ☐ Tardiness ☐ Insubordination ☐ Policy Violation ☐ Performance ☐ Misconduct ☐ Other (please describe): |
Description of Violation: | |
Reference to Company Policy/Rule Violated (if applicable): | |
PREVIOUS DISCIPLINARY ACTION
Have there been any previous disciplinary actions for this type of violation? | |
If yes, provide details (include dates and types of actions): | |
CURRENT DISCIPLINARY ACTION
Action Taken: | ☐ Verbal Warning ☐ Written Warning ☐ Suspension (with or without pay) ☐ Demotion ☐ Termination ☐ Other (please specify): |
Effective Date: | |
Details of Action Taken: | |
Employee Acknowledgment:
I acknowledge that I have received and understand this disciplinary action. I understand what is expected of me in terms of improvement and the consequences of failing to meet these expectations.
Employee Signature:
Date: [Month, Day, Year]
Supervisor Signature:
Date: [Month, Day, Year]
HR Department Signature:
Date: [Month, Day, Year]
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