DISCIPLINARY REVIEW CHECKLIST
The purpose of this document is to remind supervisors of key steps/considerations in the disciplinary
process before a supervisor or manager recommends or takes disciplinary action.
The Supervisor or Manager must complete each question by placing a check mark on either the “YES” or
1. Has the employee behaved/performed in a manner that does not comply
with a Pathfinder rule, policy or standard? _____ _____
2. Are the facts established by observation, documentation, or both? _____ _____
3. Was the employee informed of the issues and given an opportunity to
explain why discipline is not warranted? _____ _____
4. Did you consider the factors for determining the severity of discipline? _____ _____
5. To your knowledge, have similarly situated employees received similar
discipline? _____ _____
If the Supervisor or Manager answered “NO” to any of these questions and still wishes to discipline the
employee, the Director of Human Resources or Affirmative Action/Grievance Officer should be
contacted to discuss the matter.
In the case of termination, the Director of Human Resources or Affirmative Action/Grievance Officer
MUST be contacted to discuss the matter prior to issuing the termination.
Signature of Supervisor Date
NOTE: This form must be submitted to HR with a copy of the disciplinary action.
Disciplinary Action Form
Employee Name: Employee #
Action Taken: 90 day probationary Period Verbal Counseling Written Warning
1 Written Warning 2nd Written Warning Suspension # of days ( ) Termination
Corrective Action Required:
The above has been discussed with me by my supervisor. I understand the contents and acknowledge
and understand the corrective action required. I also acknowledge and understand the potential
consequences of non-compliance. All grievances must be filed within five working days of termination.
______ _______ __________
Employee Signature Date
___ _________________ _____ ______
Supervisor Signature Date