Disciplinary Notice
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This Disciplinary Notice is intended to be used as a part of your business's disciplinary
program. This Disciplinary Notice is intended to be used as a procedure to preserve a
record of an employee’s workplace behavior or performance and to attempt to correct an
employee's professional conduct in the workplace. Please use this document in your
company letterhead.
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Attorney Drafted
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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