Disciplinary Action Form

Document policy violations and record the corrective steps agreed upon with the employee.

Use this template

Name of Employee

First Name

Last Name

Position

Department

Employee Number

Infraction

Date of Incident

Annotation of Infraction

Sanction

Verbal Warning Written Warning Suspension Termination

Measures for Improvement

Employee's Signature

Sign here

Date Signed

Name of Supervisor

First Name

Last Name

Supervisor's Signature

Sign here

Date Signed

Name of HR Manager

First Name

Last Name

Human Resource Manager's Signature

Sign here

Date Signed

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