Discipline Documentation Form

Employee Information

Name of Employee:__________________________________________________________

Employee’s Job Title: ________________________________________________________

Incident Information

Date/Time of Incident:________________________________________________________

Location of Incident:_________________________________________________________

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.  ___________________________
____________________________________________________________________
____________________________________________________________________

Action Taken

What action will be taken against the employee?____________________________________
____________________________________________________________________
____________________________________________________________________

Has the impropriety of the employee’s actions been explained to the employee?  Yes	No

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

Signature of person preparing report:____________________________________________

Date:	__________________________________________________