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: __________________________________________________