[Company Name]
[Company Address Line 1] [Company Address Line 2] Record of Disciplinary Action
Employee Name: Employee Department: Date Action Taken:
Reason for Disciplinary Action: (check all that apply) ___Quality ___Safety ___Conduct ___Attendance ___ Insubordination ___ Other
Employee: You are receiving this disciplinary action because your behavior in regard to the documented incident constitutes a failure to comply with [Company] personnel policies, [Company] employee manual, and/or acceptable business practices. By conducting yourself in this way you have placed [Company] and/or your fellow [Company] employees in an injurious position. The specific inc