Disciplinary Action Form - DOC - DOC

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Disciplinary Action Form - DOC - DOC Powered By Docstoc
					Record of Disciplinary Action
Employee Name Manager Name Today’s Date Incident Time Employee Title Manager Title Incident Date Incident Location

Description of the incident that occurred: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________ Witnesses to the incident (if applicable): __________________________________________________________________________________ __________________________________________________________________________________ ____ __________________________________________________________________________________ __ Names of those in attendance at current disciplinary action meeting: __________________________________________________________________________________ __ __________________________________________________________________________________ __ __________________________________________________________________________________ __ Corrective or disciplinary action to be taken:  Verbal  Written Probation  Suspension  Other (explain below) __________________________________________________________________________________ __________________________________________________________________________________ ____ __________________________________________________________________________________ __________________________________________________________________________________ ____ (If on probation, period begins ___________________ and ends ___________________.) Goals to be Achieved: __________________________________________________________________________________ __ __________________________________________________________________________________ __ __________________________________________________________________________________ __ Consequences for failure to improve performance or correct behavior:

__________________________________________________________________________________ _ __________________________________________________________________________________ _ __________________________________________________________________________________ _ Prior discussions or warnings on this subject, whether oral or written: __________________________________________________________________________________ __________________________________________________________________________________ ____

Employee statement: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ____________

I acknowledge that I have read and understand the above information and consequences.

_______________________________ Employee Signature _______________________________ Supervisor Signature

______________________ Date ______________________ Date


				
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