Office or Department here
TO: Mr. Mike Faires
Associate Vice President for Operations
THROUGH: Mr. Julio Llanas
Director for Affirmative Action and
Mr. James A. Brown
Director of Personnel
FROM: Director’s Name
Director for Your Department
DATE: Current Date
SUBJECT: Disciplinary Action
Documentation, with dates of incidents and actions taken leading up to reason of action.
List of Recorded Disciplinary Actions
DATE RECORD DESCRIPTION OF EVENT ACTION TAKEN
Verbal Warning refusal to perform assigned After discussion with
tasks superintendent, Mr. (NAME)
agreed to do the job.
Annual Evaluation “Needs Improvement” in Recommend he remain on the
“Cleans…construction sites”, job and refrain from “joyriding”
and “…other tasks assigned
Written Warning Not on the job as assigned Closer supervision
Oral Counseling Insubordination during Instruction that this type of
Record counseling on DATE behavior will not be tolerated.
Counseling Record 1. Attendance - occasions that You must make an effort to
were leave without pay properly use your leave
because of insufficient You will be responsible for
available leave. getting your uniforms to the shop
2. Not turning in uniforms as every Friday, and must come to
scheduled for cleaning. work daily wearing a clean
3. Not following procedures uniform.
when requesting leave. You must follow the proper
procedures when requesting
Counseling Record Loafing on the job Instructions to perform his jobs
in a timely manner
Written Reprimand Leaving job site Instructions to perform his jobs
as assigned and to stay on the
Oral Warning for insufficient quantity of work Instructions to perform his jobs
in a timely manner
Office of Your Department Here
SUBJECT: Action taken
It is important to Texas Tech University, as well as the Department of employees, that
employees be trustworthy to perform their assigned duties in good faith. They are
expected to complete their assigned tasks in an efficient manner in exchange for their
Mr. Employee, you have violated that trust repeatedly by absenting yourself from and
refusing to perform your assigned tasks, thereby significantly reducing the effective
performance of yourself and (department). All corrective actions taken to modify your
behavior and ensure your proper performance have failed to obtain the desired results.
The final incident leading to this action occurred on DATE, when you (infraction). This
last incident was but a final point in an extensive history of misconduct and violation of
the trust placed in you as an employee of Texas Tech University.
Because of the circumstances described above you are hereby notified that you are being
placed on disciplinary action effective Date through Date. You are expected to return to
work at Time, Date. S/He will be required to return to work on Date and Time and
failure to do so will be considered his/her resignation from employment effective
I have been informed of and acknowledge the above.
Signing this document does not indicate my agreement.