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Employee Discipline Documentation Form
Employee Information
Name of
Employee:__________________________________________________________
Employee's Job Title:
________________________________________________________
Incident Information
Date/Time of
Incident:________________________________________________________
Location of
Incident:_________________________________________________________
Description of
Incident:_______________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Witnesses to
Incident:________________________________________________________
Was this incident in violation of a company policy? Yes No
If yes, specify which policy and how the incident violated it.
___________________________
____________________________________________________________________
____________________________________________________________________
Action Taken
What action will be taken against the
employee?____________________________________
____________________________________________________________________
____________________________________________________________________
Has the impropriety of the employee's actions been explained to the
employee? Yes No
Did the employee offer any explanation for the conduct? If so, what
was it? ______________ _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
Signature of person preparing
report:____________________________________________
Date: __________________________________________________

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