Sample Report of Employee Discipline 1. 2. 3. 4. 5. Name of Employee: Employee’s Job Title: Date/Time of Incident: Location of Incident: Description of Incident:
6. 7.
Witnesses to Incident: Did this incident violate a company policy? Yes No a) If yes, specify which policy and how the incident
violated it.
8.
Has the impropriety of the employee’s actions been
explained to the employee? Yes 9. No
Employee’s explanation for the misconduct:
10.
Disciplinary action taken against employee:
Date:
Signed: