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Disciplinary Counseling Report




Name:

Dept:

Date:

Date of occurrence:

Time:

Location:

ACTION TAKEN:

□ Coaching

□ Verbal warning

□ Written warning

□ Suspension_____day(s)

□ Termination

□ Other:

(Depending on the nature of the offense, [Company Name] reserves the right to skip any steps at its discretion.)


DESCRIPTION OF ISSUE:

□ Absenteeism

□ Conduct

□ Safety violation

□ Policy and/or procedure violation

□ Unsatisfactory job performance

□ Other:


EXPLANATION:



GOALS/CORRECTIVE BEHAVIOR:

Should your record continue to be unacceptable in the above area(s), the company will find it necessary to take the following disciplinary action (or more depending on the situation):

□ Written warning

□ Suspension _____day(s)

□ Termination

□ Other:

EMPLOYEE COMMENTS:



You are formally being warned to bring to your attention the severity of this situation. Failure to correct this behavior and/or further violation of company policy will result in additional disciplinary action up to and including discharge. By signing below you acknowledge that you have received this notice.

Employee: __________________________________________________

Date: __________

Supervisor: __________________________________________________

Date: __________

HR Manager: ________________________________________________

Date: __________



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