Disciplinary Action Form

Document incidents and corrective steps

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Disciplinary Action Form Template

DISCIPLINARY ACTION FORM

Date: [Date] | Form ID: [ID]

1. EMPLOYEE INFORMATION

Employee Name:

[Employee Name]

Employee ID:

[Employee ID]

Position/Title:

[Position]

Department:

[Department]

Hire Date:

[Hire Date]

Supervisor:

[Supervisor Name]

2. INCIDENT DETAILS

Date of Incident:

[Date]

Time of Incident:

[Time]

Location:

[Location]

Description of Incident:

[Detailed description of what occurred, including specific behaviors, actions, or violations observed]

3. INVESTIGATION

Investigation Conducted By:

[Investigator Name & Title]

Investigation Date:

[Date]

Witnesses Interviewed:

[List names and contact information of witnesses]

Evidence Reviewed:

[List documents, records, or other evidence reviewed]

4. POLICY VIOLATION

Policy/Procedure Violated:

[Specific policy or procedure]

Severity Level:

Minor - First offenseModerate - Repeated offense or serious violationMajor - Serious misconduct or safety violation

5. CORRECTIVE ACTION

Action Taken:

Specific Corrective Measures:

[Detailed description of corrective actions, training requirements, or performance improvement plans]

Expected Improvement:

[Clear expectations for future behavior and performance]

6. EMPLOYEE ACKNOWLEDGMENT

Employee Response:

[Space for employee to provide their perspective or response]

Employee Signature:

Date: _______________

Supervisor Signature:

Date: _______________

7. FOLLOW-UP

Follow-up Date:

[Date]

Follow-up Notes:

[Space for follow-up observations and outcomes]

Legal Notice: This form should be reviewed by legal counsel before use. Ensure compliance with local labor laws and company policies. Maintain confidentiality and proper documentation procedures.

Usage Guidelines

When to Use This Form

Employee performance issues that require documentation
Policy violations that need formal correction
Behavioral issues that impact workplace safety or productivity
Attendance or punctuality problems
Insubordination or unprofessional conduct

Best Practices

Conduct thorough investigation before taking action
Document all incidents objectively and factually
Provide clear expectations for improvement
Follow progressive discipline when appropriate
Maintain consistency across similar situations
Keep all documentation confidential and secure