EMPLOYEE DISCIPLINARY ACTION FORM

Employee Name: [NAME]
Employee ID: [ID]
Department: [DEPARTMENT]
Supervisor: [SUPERVISOR]
Date of Action: [DATE]

1. Type of Action

☐ Verbal Warning
☐ Written Warning
☐ Final Warning
☐ Suspension
☐ Performance Improvement Plan
☐ Other: [OTHER]

2. Description of Issue

[DESCRIBE THE INCIDENT, DATES, AND FACTS]

3. Policy or Expectation Violated

[POLICY/EXPECTATION]

4. Prior Counseling or Discipline

[DETAILS OR "NONE"]

5. Corrective Action Required

[REQUIRED ACTIONS, DEADLINES, AND PERFORMANCE EXPECTATIONS]

6. Consequences of Failure to Improve

Failure to meet expectations may result in further discipline, up to and including termination.

7. Employee Response (Optional)

[EMPLOYEE RESPONSE]

Employee Signature: ______________________________
Date: [DATE]

Supervisor Signature: ____________________________
Date: [DATE]

HR Signature: ___________________________________
Date: [DATE]