Disciplinary Notice

Employee Name:

Date:

Informal Warning

Formal Warning

Final Warning

Dismissal

1. Statement of the problem: (violation of rules, standards, practices or unsatisfactory performance.)

2. Prior discussion or warnings on this subject: (oral, written, dates.)

3. Statement of company policy on this subject:

4. Summary of corrective action to be taken: (Include dates for improvement and plans for follow-up.)

5. Consequences of failure to improve performance or corrective behavior:

6. Employee comments:

Employee Signature

Supervisor Signature

________________________ Date

__________

________________________ Date __________

Distribution: One copy to Employee, one copy to Manager and original copy to Human Resources.