DISCIPLINE DOCUMENTATION NOTICE

Employee Information

Name:

Job Title:

Department:

Incident Information

Date/Time:

Place:

Description:

Witnesses:

Was this incident a violation of a company policy? Yes No

Standard operating procedure? Yes No

A management order? Yes No

If yes, specify which policy or procedure and how the incident violated it.

Next Steps

What actions have been taken in the past when incidents like this occurred?

What action will be taken against this employee?

Has the problem with the employees actions been discussed with the employee? Yes No

Did the employee offer any explanation for the incident? Explain.

Signature of manager preparing report:

Date:

Any employee rebuttal: