What Disciplinary Action Form Template consists of?
The Disciplinary Action Form Template is a document used by employers to record instances of employee misconduct or poor performance. It includes employee details, date, and time of the incident, along with a brief description of the misconduct. This form serves as a formal record and may be used in the disciplinary process.
Template
[Company Name]
[Date]
Disciplinary Action Form
Employee Information:
- Name: [Employee’s Full Name]
- Job Title: [Employee’s Job Title]
- Department: [Employee’s Department]
- Date of Incident: [Date of the Incident]
Description of Incident:
[Provide a detailed description of the incident or behavior that led to the disciplinary action. Include dates, times, locations, witnesses, and any relevant information.]
Previous Discussions and Warnings:
[Specify any previous discussions, verbal warnings, or written warnings related to the employee’s behavior or performance.]
Violated Policies or Expectations:
[Identify the company policies, rules, or performance expectations that the employee has violated.]
Disciplinary Action Taken:
[Select the appropriate disciplinary action taken from the following options:]
- Verbal Warning: A formal verbal warning issued to the employee about their conduct or performance.
- Written Warning: A written warning documenting the employee’s violation and outlining the consequences of further infractions.
- Suspension: Temporary suspension from work, with or without pay, based on the severity of the violation.
- Probation: Placement on a probationary period, during which the employee’s performance will be closely monitored.
- Demotion: A change in the employee’s job title or role as a result of the violation.
- Termination: Termination of employment based on the severity of the violation and/or repeated infractions.
Disciplinary Action Details:
[Provide additional details about the disciplinary action, including the date of the action, the person responsible for implementing the action, and any conditions or requirements for improvement.]
Employee’s Response:
[Allow the employee to provide their response to the disciplinary action. Include a section for the employee to acknowledge receipt of the form.]
Action Plan and Follow-Up:
[If applicable, outline any action plan or performance improvement plan for the employee to follow. Specify a timeline for improvement and any support or resources provided to help the employee meet expectations.]
Employee Acknowledgment:
I, [Employee Name], acknowledge that I have received a copy of this Disciplinary Action Form and understand the details of the disciplinary action being taken. I have had the opportunity to discuss the incident and the disciplinary action with my supervisor.
Employee’s Signature: [Employee’s Signature]
Date: [Date]
Supervisor’s Comments:
[Supervisor’s comments on the disciplinary action, including any additional instructions or support provided to the employee.]
Supervisor’s Signature: [Supervisor’s Signature]
Date: [Date]
HR Representative’s Comments:
[HR representative’s comments on the disciplinary action, including any additional information or follow-up steps.]
HR Representative’s Signature: [HR Representative’s Signature]
Date: [Date]
Witness (if applicable):
- Full Name: [Full Name]
- Signature: [Signature]
- Date: [Date]
Final Notes:
[Add any additional comments, remarks, or notes related to the disciplinary action.]
This Disciplinary Action Form will be placed in the employee’s personnel file for record-keeping purposes. All parties involved should retain a copy of this form for their records.
[Company Name] is committed to providing a fair and respectful workplace for all employees. We expect all employees to adhere to company policies and performance standards to maintain a positive work environment.
Copy Distribution:
- Employee
- HR Department (if applicable)
- Employee’s Supervisor
- Employee’s Personnel File
