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Disciplinary Write-Up Form Template

When an employee incites an incident in the workplace, swift action must be taken to discourage such behavior with a disciplinary action write-up template. Whether the employee is consistently late to work, engaging in inappropriate behavior, or has made a costly mistake, you can use this template to help get them back on track. This checklist template contains the following fields:

  • • Violation
  • • Violation description
  • • Action
  • • Consequences of further infractions
  • • Acknowledgement and sign off

You might also be interested in the employee incident report form and the non-conformance report.

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Employee Name
Picture of violation
Violation Date & Time
Type of warning
Other description:
VIOLATION DESCRIPTION (check all that apply)
Tardiness / Leaving Early
Violations of Company Policies
Drinking / Drugs at Work
Damage to Material/ Equipment / Property
Failure to come to work prepared
Substandard Work
Violation of Safety Rules
Unsatisfactory Behavior Towards Others
Tardiness or Absenteeism
Dress Code Violation
Other description:
Description of Violation - Specifics
Consequences of Further Infractions
Acknowledgement (Check Proper Box)
I agree with the violations identified in this report
I disagree with the violations identified in this report because:
Employee Signature
Manager Signature
Witness Signature
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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