Disciplinary Warning

Date:

Employee:

Position:

Date of Incident:

Incident:

Reason for Notice:

Action taken on this notice:

[ ] First Warning - Verbal

[ ] Second Warning - Written

[ ] Suspension for__________ days

[ ] Other (specify):

Next step for repeated infraction:

[ ] Second Warning - Written

[ ] Suspension for __________ days

[ ] Other (specify):

Supervisor Comments: _

Employee Comments:

_____________________ Date:

Supervisor

______________________ Date:

Employee

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Disciplinary Warning