Social Security Number:
RE: (State the type of warning) VERBAL WARNING – (State the reason why) Unavailable for Work
and Failure to Comply with (Practice Name) Policies and Procedures.
You are being given this verbal warning due to you continued unavailability for work and failure to
comply with (Practice Name) Policies and Procedures Number (state policy and procedure number and
attach a copy to this report).
The facts supporting this verbal warning are: (Justify the warning)
Your schedule shift time begins at 8:30 a.m.
You failed to report to work on September 27, and failed to call in until 10:30 a.m.
You failed to report to work on October 3, and failed to call in until 9:15 a.m.
You failed to report to work on October 11, and failed to call in until 9:25 a.m.
Your continued unavailability for work and your continued failure to comply with (Practice Name)
policies and procedures poses a hardship on the practice. When you are not at work, the clinic is unable to
provide optimum care to the patients. Your supervisor has to arrange for other employees to cover your
assigned duties. Your continued absence negatively impacts the overall efficiency of the practice.
(State what the employee must do to correct their behavior) Immediate and lasting correction of this
behavior must be made. You must follow (Practice Name) Policy and Procedure regarding:
Report to work on time, as scheduled every day, and work the hours scheduled for your position.
Follow attendance and call-in procedures.
(State what you can do to help the employee correct their behavior) Management is available to discuss
your questions and concerns regarding your responsibilities.
Failure to adhere to the (Practice Name) Policies and Procedures will subject you to further disciplinary
action, which may include termination.
(Type Name of Office Manager and Sign) (Type Name of Physician Name and Sign)
THIS REPORT HAS BEEN DISCUSSED WITH ME.
Employee's Signature Date