Employee Discipline Form
Today's Date
 -
Month
 -
Day
Year
Date
Employee ID
Employee Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Position/Title
Department
Reason of disciplinary action
Attendance
Disobedience
Safety
Quality of work
Other
More details about the violation or offense
Date of the offense
 -
Month
 -
Day
Year
Date
Time of the offense
Hour Minutes
AM
PM
AM/PM Option
Was the employee received any warnings previously?
Yes
No
Is it for the same violation or offense?
Yes
No
How many instances for the same offense?
When was the previous warning given to the employee?
 -
Month
 -
Day
Year
Date
Is it verbal or written warning?
Verbal warning
Written warning
Please upload any supporting documents related to this disciplinary action
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Employee's reply or statement
Action plan
Recommended action of the immediate supervisor
Verbal coaching
Written reprimand
Final warning
Suspension
Termination
Other
Effectivity date of the disciplinary action
 -
Month
 -
Day
Year
Date
Supervisor's Name
First Name
Last Name
Supervisor's Signature
Date Signed
 -
Month
 -
Day
Year
Date
By signing below, you agree that all information in this document is accurate and true.
Employee Signature
Date Signed
 -
Month
 -
Day
Year
Date
Submit
Should be Empty: