# 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.**