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Employee Disciplinary Action (Discipline) Form

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An employee disciplinary action form is designed to inform an Employee, unable to follow the policies or expectations set by his or her Employer, of the result(s) of his or her action(s).  The punitive action defined in this form will usually be unwelcome by most employees, so it would be considered wise to document it, then present it in writing. A standardized document will make sure to keep this action on a professional level while, at the same time, providing a hard copy record which each party should keep for future reference.

How to Write

Step 1 – The buttons on the right (“PDF,” “ODT,” and “Word”) will allow a download of the Employee Disciplinary Action Form as the file type they denote. Download the form you prefer to work onto your machine.

Step 2 – On the line labeled “Employee,” report the Full Name of the Employee receiving Disciplinary Actions.

Step 3 – Enter the Date this Notice is being issued on the line labeled “Date of Warning.”

Step 4 – Report the Department the Employee being disciplined works in on the blank space labeled “Department.”

Step 5 – Report the Full Name of the Employee’s Supervisor on the blank line labeled “Supervisor.”

Step 6 – Locate the check boxes in the “Type of Violation” section. Each one will have a label: Attendance, Carelessness, Disobedience, Safety, Tardiness, Work Quality, or Other. Select the check box that best describes the reason for disciplinary action against the Employee. If the reason is not listed, then select the box labeled “Other” and report the reason for this action on the space provided.

Step 7 – Next, in the “Warning” section, report the Date the Employee breached company policy in a way that requires correction on the blank line labeled “Violation Date.” If possible, report the Time of day this occurred on the blank space labeled “Violation Time.” On the blank line labeled “Violation location,” report the Address where the Employee breached company policy.

Step 8 – The next two sections will provide an area so the Employer and the Employee may both supply a statement regarding the Employee Violation in focus and/or this form. The Employer may submit his or her statement in the area labeled “Employer’s Statement” and the Employee may submit his or her statement in the area labeled “Employee’s Statement.”

Step 9 – You may report the Final Decision on whether Disciplinary Action should be taken, as well as what Action should be taken in the “Decision” section. The individual who approves this decision must supply his or her Name on the blank line labeled “Decision Approved by,” report his or her job position on the blank line labeled “Title,” and enter the Date this Decision was approved on the blank line labeled “Date.”

Step 10 – The next section, “Previous Warnings,” requires a report on any history of warnings that may exist. There will be three blank lines labeled as “1st Warning – Date,” “2nd Warning – Date,” and “3rd Warning – Date” each followed with a check box for “Verbal” and a check box for “Written.” Utilize this area to define the Date a Warning was given to the Employee and whether that warning was delivered orally or in written form.

Step 11 – The next section, “Signatures,” will serve to validate this document with the Employer and Employee this form concerns itself with. The Employer will need to Sign his or her Name on the blank line following the words “Employer’s /Supervisor’s Signature.” After the Signature he or she must provide a Date on the field labeled “Date.” Below this, the Employer or Supervisor must Print his or her Name on the blank line labeled “Print Name.” The Supervisor must then enter his or her Job Position on the blank line.

Step 12 – The Employee facing Disciplinary Actions will need to read the Acknowledgement Statement then provide his or her Signature, Signature Date, Printed Name, and Title on the blank spaces provided.

Step 13 – Next submit this Notice to the appropriate Department in the Company or Organization that will be disciplining its Employee.






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