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Disciplinary Action Form

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Please note: This sample Disciplinary Action Form is provided for you by HR.com as a free service. The free hr templates and forms on this site are general in nature and not based on the laws of any specific state or other jurisdiction. Prior to using these policies or forms, we recommend that you consult with an attorney or other expert knowledgeable in the laws of the applicable jurisdiction and the specific intended use of those documents.

Disciplinary Action

Employee Name:	Employee Title:
Manager Name:	Manager Title:
Today´s Date:	Incident Date:
Incident Time:	Incident Location:

Witnesses: (if applicable)

____________________________________________________________________________________

Policies Violated:

____________________________________________________________________________________

Description of the incident that occurred:

____________________________________________________________________________________

Disciplinary action to be taken: (circle appropriate category)

Verbal Written Suspension Other (if so, please explain below)

____________________________________________________________________________________

Consequences of repeat offences:

____________________________________________________________________________________

Employee explanation: (if provided)

____________________________________________________________________________________

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

____________________________________________________________________________________

Employee Signature

__________________________________

Date

_____________________________________________________________________________________

Supervisor Signature

___________________________________

Date

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Disciplinary Action Form