DISCIPLINARY ACTION
Date: Employee: Immediate Supervisor: Department:
Action taken:
Verbal Warning
Written warning
Suspension
Termination
Reason for Conference: (completed by Supervisor) Describe reason for disciplinary action (i.e. policy or department violation, performance issue, etc.) Include applicable policy if appropriate. Include date of previous disciplinary action (if relevant to current issue).
Performance Improvement Plan: Identify specific expectations, timeframes (if appropriate), next step, etc.
I understand that failure to improve my performance as described above will result in further corrective action, up to and including the termination of my employment.
____________________ Employee Signature
Refused to sign above
_____________ Date
____________________ Supervisor Signature
_____________ Date
_________ I acknowledge receipt of a copy of this record.
Employee to initial & date
____________________ Witness Signature
_____________ Date
Copy to Employee Copy to Employee’s Departmental File Copy to Human Resources for Employee File