Employee Disciplinary Action Follow Up Form
Counseling Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Name
First Name
Last Name
Job Title
Supervisor Name
First Name
Last Name
Type of Violation:
Poor performance
Absence/Tardiness
Violation of company policy
Insubordination
Falsification of documents/records
Harrasment
Safety violation
Other
Disciplinary Action Taken:
Verbal warning
Written warning
Suspension
Termination
Other
Brief Information About Violation:
Summary of Disciplinary Action:
Employee Comments:
Supervisor Comments:
Follow Up Date:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Signature
Supervisor Signature
Submit
Should be Empty: