Employee Disciplinary Action Form

EMPLOYEE DISCIPLINARY ACTION FORM

CONFIDENTIAL

Form Number: [________________________________]
Date of Issuance: [__/__/____]

SECTION 1: EMPLOYEE INFORMATION

SECTION 2: TYPE OF VIOLATION

Check all that apply:

2.1 Attendance and Punctuality

☐ Excessive absenteeism
☐ Unexcused absence(s)
☐ Pattern of tardiness
☐ Failure to follow call-in/notification procedures
☐ Job abandonment
☐ Excessive use of unscheduled leave

2.2 Performance

☐ Failure to meet job performance standards
☐ Failure to meet productivity requirements
☐ Failure to follow instructions or directives
☐ Failure to complete assigned work
☐ Negligence or carelessness in performing duties
☐ Unsatisfactory quality of work

2.3 Conduct and Behavior

☐ Insubordination (refusal to follow lawful directive)
☐ Disruptive behavior
☐ Unprofessional conduct
☐ Use of inappropriate or offensive language
☐ Violation of dress code or grooming policy
☐ Sleeping on the job
☐ Unauthorized absence from workstation

2.4 Policy Violations

☐ Violation of Company handbook or policies (specify below)
☐ Violation of safety rules or procedures
☐ Violation of electronic communications / social media policy
☐ Violation of drug-free workplace policy
☐ Unauthorized use of Company property or resources
☐ Violation of confidentiality or data protection policy
☐ Violation of conflict of interest policy

2.5 Serious Misconduct

☐ Harassment (sexual, racial, or other protected-class-based)
☐ Discrimination
☐ Retaliation against another employee
☐ Workplace violence or threats of violence
☐ Theft, fraud, or dishonesty
☐ Falsification of records or documents
☐ Possession or use of drugs or alcohol on Company premises
☐ Unauthorized disclosure of confidential information
☐ Criminal conduct related to employment

2.6 Other

☐ Other (describe): [________________________________]

Specific policy or rule violated:
[________________________________]
Handbook section / policy reference:
[________________________________]

SECTION 3: LEVEL OF DISCIPLINARY ACTION

Select the level of discipline being issued:

☐ Level 1: Verbal Counseling / Coaching
(Documented conversation; no formal written warning issued.)

☐ Level 2: Written Warning
(Formal written documentation of the issue and expectations.)

☐ Level 3: Final Written Warning
(Last opportunity to correct behavior before further action.)

☐ Level 4: Suspension Without Pay
Duration: [____] days
Suspension dates: From [__/__/____] to [__/__/____]

☐ Level 5: Performance Improvement Plan (PIP)
PIP start date: [__/__/____]
PIP end date: [__/__/____]
PIP duration: [____] days

☐ Level 6: Demotion
New position: [________________________________]
New pay rate: $[________________________________]
Effective date: [__/__/____]

☐ Level 7: Termination of Employment
Effective date: [__/__/____]
(Complete termination documentation separately.)

SECTION 4: DESCRIPTION OF INCIDENT(S)

4.1 Incident Details

4.2 Factual Description

Describe the specific conduct, incident, or performance deficiency in objective, factual terms. Include what happened, when, where, who was involved, and the impact on the workplace.

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

4.3 Additional Incidents (If Applicable)

Incident 2:
Date: [__/__/____] | Location: [________________________________]
Description:
[________________________________]
[________________________________]
[________________________________]

Incident 3:
Date: [__/__/____] | Location: [________________________________]
Description:
[________________________________]
[________________________________]
[________________________________]

4.4 Impact of Conduct

Describe the impact of the employee's conduct on the workplace, team, customers, operations, or safety:

[________________________________]
[________________________________]
[________________________________]

SECTION 5: PRIOR WARNINGS AND DISCIPLINARY HISTORY

☐ No prior disciplinary actions on record.

Are prior warnings related to the current issue? ☐ Yes ☐ No
Were prior corrective actions effective? ☐ Yes ☐ No ☐ Partially

SECTION 6: CORRECTIVE ACTION PLAN

6.1 Expected Standards and Behaviors

The employee is expected to meet the following standards immediately and on an ongoing basis:

6.2 Support and Resources Provided

The Company will provide the following support to assist the employee in meeting expectations:

☐ Additional training: [________________________________]
☐ Mentoring or coaching: [________________________________]
☐ Adjusted workload or duties (temporary): [________________________________]
☐ Employee Assistance Program (EAP) referral
☐ Clear written instructions or procedures: [________________________________]
☐ Regular check-in meetings with supervisor (frequency: [________________________________])
☐ Other: [________________________________]

6.3 Follow-Up Schedule

SECTION 7: CONSEQUENCES OF CONTINUED VIOLATIONS

The employee is advised that failure to meet the expectations set forth in this disciplinary action may result in further disciplinary action, up to and including:

☐ Additional written warning
☐ Final written warning
☐ Suspension without pay
☐ Demotion
☐ Termination of employment
☐ Other: [________________________________]

SECTION 8: AT-WILL EMPLOYMENT SAVINGS CLAUSE

IMPORTANT: This disciplinary action form and the Company's progressive discipline procedures do not alter the at-will nature of the employment relationship. [COMPANY NAME] retains the right to terminate employment at any time, with or without cause, and with or without following progressive discipline steps. The Company reserves discretion to determine the appropriate level of discipline for any situation, and progressive steps are not required.

Nothing in this form constitutes a contract of employment or a guarantee of continued employment. This form does not create any express or implied promise that employment will continue for any specific period or that termination will occur only through progressive discipline.

Montana Exception: For employees working in Montana, this savings clause does not apply to the extent inconsistent with the Montana Wrongful Discharge from Employment Act, Mont. Code Ann. 39-2-901 et seq.

SECTION 9: DUE PROCESS PROVISIONS (Public-Sector Employers Only)

FOR PUBLIC-SECTOR EMPLOYERS -- Complete for suspensions, demotions, or terminations where the employee has a property interest in continued employment:

9.1 Pre-Disciplinary (Loudermill) Notice

9.2 Pre-Disciplinary Hearing

9.3 Post-Hearing Decision

SECTION 10: ADA / FMLA / ACCOMMODATION REVIEW

Before issuing this disciplinary action, the following have been reviewed:

If any of the above answers indicate a potential accommodation, leave, or retaliation issue, consult with HR and legal counsel before proceeding with discipline.

SECTION 11: WITNESS STATEMENTS

Witness 1

Witness 2

Additional Witnesses

[________________________________]

SECTION 12: EMPLOYEE RESPONSE

The employee has the right to provide a written response to this disciplinary action. The response will be attached to this form and placed in the employee's personnel file.

☐ Employee provided a response (attached).
☐ Employee declined to provide a response.
☐ Employee reserved the right to provide a response by: [__/__/____].

Employee Response:

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

SECTION 13: SIGNATURES

Employee Acknowledgment

By signing below, I acknowledge that I have received and reviewed this disciplinary action form. I understand the expectations set forth and the potential consequences of failing to meet those expectations. My signature does not necessarily indicate agreement with the contents of this form.

☐ Employee refused to sign. (See Section 13A below.)

13A: Refusal to Sign

If the employee refuses to sign this form, document the refusal below. The employee's refusal to sign does not invalidate the disciplinary action.

Supervisor/Manager Signature

Human Resources Representative Signature

Second-Level Manager (if required by policy)

SECTION 14: DISTRIBUTION AND FILING

SOURCES AND REFERENCES

1. Cleveland Board of Education v. Loudermill -- 470 U.S. 532 (1985) (public employees with a property interest in employment are entitled to pre-deprivation due process: notice of charges, explanation of evidence, and opportunity to respond).
2. Americans with Disabilities Act (ADA) -- 42 U.S.C. 12101 et seq. (employers must engage in the interactive process and consider reasonable accommodations before disciplining employees whose conduct may be related to a disability).
3. Family and Medical Leave Act (FMLA) -- 29 U.S.C. 2601 et seq. (FMLA-qualifying absences may not be counted against employees under attendance policies; 29 CFR 825.220 prohibits interference with FMLA rights).
4. Title VII of the Civil Rights Act of 1964 -- 42 U.S.C. 2000e et seq. (discipline must be applied consistently regardless of race, color, religion, sex, or national origin; disparate treatment in discipline is actionable).
5. National Labor Relations Act (NLRA) -- 29 U.S.C. 151 et seq. (Section 7 protects concerted activity; discipline for protected activity may constitute an unfair labor practice; Weingarten rights entitle unionized employees to representation during investigatory interviews).
6. FLSA Salary Basis -- Exempt Employee Suspensions -- 29 CFR 541.602(b)(5) (exempt employees may be suspended without pay in full-week increments or for violations of workplace conduct rules of major significance; partial-week unpaid suspensions may jeopardize the exemption).
7. Pregnant Workers Fairness Act -- 42 U.S.C. 2000gg et seq. (effective June 27, 2023; requires reasonable accommodations for pregnancy-related conditions).
8. USERRA -- Uniformed Services Employment and Reemployment Rights Act, 38 U.S.C. 4301 et seq. (prohibits adverse employment actions based on military service).
9. Progressive Discipline Best Practices -- See SHRM guidelines on progressive discipline; documentation should be objective, specific, and consistent.
10. At-Will Savings Clause -- Necessary in approximately 36 states recognizing implied contract exceptions to at-will employment; see Toussaint v. Blue Cross & Blue Shield of Michigan, 408 Mich. 579 (1980).

This template is provided by ezel.ai for informational purposes only and does not constitute legal advice. Disciplinary procedures must comply with applicable federal, state, and local employment laws, collective bargaining agreements, and civil service regulations. This document must be reviewed and customized by a qualified attorney before use. No attorney-client relationship is created by use of this template.