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Disciplinary Action Form

March 10, 2008

This Disciplinary Action form is used by an employer to document a warning to an employee for his or her unsatisfactory performance. It details the shortcomings and clearly states consequences for non improvement or recurrence. It is signed by both the employer and the employee being warned.

Disciplinary Action Form

Date: ____________________

Name: _________________________________ Dept.: __________________________________

Disciplinary Action:

Verbal__Written__Written & Suspension Discharge

To the employee: Your performance has been found unsatisfactory for the reasons set forth below. Your failure to improve or avoid a recurrence will be cause for further disciplinary action, up to and including termination. Details:________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

A copy of this warning was personally delivered to the above employee by:


Supervisor _______________________________________ Date

I have received and read this warning notice. I have been informed that a copy of this notice will be placed in my personnel file.


Employee _______________________________________ Date


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