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Disciplinary Report Form

When is this form used? DISCIPLINARY REPORT FORM

Employee: Position: _
• Any time there is a need to document disciplinary action
Date of Occurrence: Time: : AM PM

Location:
Description of Incident (Check All That Apply)
Action Taken (Check One)
SAMPLE
taken to correct employee behvior . This form is placed in Verbal Warning       Absence




Tardiness

Written Warning

Conduct
Final Written Warning

the employee file once the employee and manager sign . Further Explanation:         Health/Safety Violation _
Policy Violation
Substandard Performance
Other:

Did Manager/Supervisor Observe Behavior?


Yes

If No, who brought this incident to the Supervisor’s attention?
No



Goals to correct Problem:

Consequences of failure:
Re-evaluation meeting scheduled for (if applicable):
Employee Comments:

You are formally being warned to bring to your attention the severity of this situation. Failure to correct
this behavior and/or further violation of company policy will result in additional disciplinary action up to
and including discharge. By signing below you acknowledge that you have received this notice.

Employee Signature: Date:

GM / Mgr. Signature: Date:

Other Signature: Date:
(If required)

Original goes in personnel file and make a copy for the employee.

FRC 12/2016
Final Pay Form (2 Versions)
When is this form used?
• Upon termination of employment (according to state laws - see state laws on termination)
SAMPLE SAMPLE
SAMPLE

(CA, CO, NV) (General Form)

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PAYROLL 26 Revised November 2016