Below is the  Record Of Disciplinary Action And Proposed Changestemplate body. If necessary, please put the personal information, company information, such as text to replace the specific content you need. you can download the .doc template file on the end of the article by click download link. 

RECORD OF DISCIPLINARY ACTION



Employee Name
Employee Title

Manager Name
Manager Title

Todays Date
Incident Date

Incident Time
Incident Location



Description of Incident
                                                                                                        


Witnesses to Incident:
                                                                              


Was this incident in violation of a company policy?        (Yes       (No


If yes, specify which policy and how the incident violated it.  
                                                                                

Names of those in attendance at current disciplinary action meeting:
                                                                              

What action will be taken against the employee?
                                                                                                        


Has the impropriety of the employees actions been explained to the employee?    (Yes        (No


Did the employee offer any explanation for the conduct?  If so, what was it? 
                                                                                                        

Corrective or disciplinary action to be taken: 

( Verbal     (  Written    ( Probation    (  Suspension     (  Other (explain below)
                                                                              
(If on probation, period begins     and ends    )


Goals to be Achieved:
                                                                              

Consequences for failure to improve performance or correct behavior:
                                                                              

Prior discussions or warnings on this subject, whether oral or written: 
                                                                              

Employee statement: 
                                                                                                                                                            


I acknowledge that I have read and understand the above information and consequences.



                      
Employee Signature          Date


                      
Supervisor Signature          Date



Distribution: One copy to Employee, one copy to Supervisor and original to Personnel File. 




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