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Minnesota Disciplinary Notice

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                             This Disciplinary Notice is intended to be used by an employer as a part of its disciplinary
                             program. This notice should be used as a procedure to preserve a record of an employee's
                             non-performance or misbehavior in the workplace. It also offers the employee ways to
                             improve performance or correct behavior. Documentation of employee discipline is
                             important for fairly informing an employee of performance problems and for creating a trail
                             of documentation for potential legal actions. This notice is useful to companies located in
                             Minnesota when dealing with employees with performance or behavioral issues.
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                                     DISCIPLINARY NOTICE


Employee Name: ________________________
Department: ____________________________
Position: _______________________________
[Instruction: Insert the description of the employee]


Date of Incident: _____ [Month] _____ [Date], 20_____.


[Instruction: Insert the type of warning and mark “X” next to the applicable clause]
                         ______Written Warning           _____Final Warning


1. STATEMENT OF THE PROBLEM:
   _____________________________________________________________________________________________________
   _____________________________________________________________________________________________________
   _______________________
   [Instruction: Insert the type of problem and act of employee, E.g., violation of
   rules, policies, standards, practices or unsatisfactory performance.]


2. PRIOR          DISCUSSION           OR        WARNINGS            ON         THIS        SUBJECT:
   __________________________________________________________________________
   _____________________________________________________________________________________________________
   _________________________________________________
   [Instruction: Insert any prior oral or written, discussion or warning on this
   subject.]


3. STATEMENT             OF        COMPANY             POLICY        ON         THIS        SUBJECT:
   __________________________________________________________________________
   _____________________________________________________________________________________________________
   _________________________________________________
   [Instruction: Insert company policy on the act of employee.]
4. SUMMARY              OF           CORRECTIVE          ACTION           TO         BE        TAKEN:
    __________________________________________________________________________
    _____________________________________________________________________________________________________
    _________________________________________________
    [Instruction: Insert summary of corrective action to be taken including dates for
    improvement and plans for follow up]


5. CONSEQUENCES OF FAILURE TO IMPROVE PERFORMANCE OR CORRECT
    BEHAVIOR: __________________________________________________________________________
    _____________________________________________________________________________________________________
    _________________________________________________
    [Instruction: Insert penalty for failure to improve performance or correct
    behavior]


6. EMPLOYEE COMMENTS:
    __________________________________________________________________________
    _____________________________________________________________________________________________________
    _________________________________________________




__________________________________              _____ [Month] _____ [Date], 20_____
[Instruction: Insert signature of employee]
___________________________________             _____ [Month] _____ [Date], 20_____
[Instruction: Insert signature of supervisor]




Distribution: One Copy to Employee, one copy to Supervisor and original copy to
Personnel File
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Description: This Disciplinary Notice is intended to be used by an employer as a part of its disciplinary program. This notice should be used as a procedure to preserve a record of an employee's non-performance or misbehavior in the workplace. It also offers the employee ways to improve performance or correct behavior. Documentation of employee discipline is important for fairly informing an employee of performance problems and for creating a trail of documentation for potential legal actions. This notice is useful to companies located in Minnesota when dealing with employees with performance or behavioral issues.
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