Employment Disciplinary Action Form (With Template & Sample)

An established protocol for addressing inadequate employee performance or policy violations is vital. A disciplinary procedure sets professional expectations for the entire company. This article outlines the components of a disciplinary action form, when to use one and how to write one.

 

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What is a disciplinary action form?

An employee disciplinary action form informs an individual of their inability to meet employment expectations and includes actions that will be taken as a result. Upon completion, these documents are typically stored in the employee’s file, providing the employer with a complete record of an individual’s past behavior.

 

Disciplinary action forms document violations and ensure professional interactions during disciplinary procedures. These warnings can reduce turnover because they clearly define steps an employee can take to improve their performance. When there is a termination, disciplinary action forms can serve as evidence if there is a dispute.

 
Related: Exit Interview Form

 

When to use a disciplinary action form

Company policies and expectations for professional behavior should be outlined in your company’s employee handbook. In most cases, disciplinary action forms are issued after a verbal warning for the same or similar behavior. Disciplinary action is commonly taken for:

 

  • Violation of company policies or procedures
  • Excessive tardiness or absenteeism
  • Issues with work quality or performance
  • Safety violations
  • Inappropriate conduct

 

What to include in a disciplinary action form

A disciplinary action form should include relevant information including:
 

  • First and last name of the employee
  • Date of the incident
  • Summary of the issue or event, including witnesses, location, times and dates
  • Past events or behavior relating to current violation
  • Employee comments
  • Corrective actions and dates
  • Additional comments or information provided by the person preparing the form
  • Name of the employee’s direct supervisor
  • Signature of the employee acknowledging the disciplinary action and suggested improvements
  • Signature of the person preparing the disciplinary action form

 

How to fill out a disciplinary action form

Completing an employee disciplinary action form is fairly straightforward, but it’s important to fill out each section completely and to the best of your ability.

 

Some sections are more simple to fill out than others. For example, information like the date of the incident and employee name is relatively easy to determine. On the other hand, uncovering specific details surrounding the incident and determining appropriate corrective actions takes a little more detective work and thought.

 

Here are some tips filling an employee disciplinary action form:

 

Be specific and detailed about the incident. For instance, instead of writing that an employee was disrespectful, provide details about their actions or words that showed disrespect.

 

Document witness statements. If applicable, collect and and include statements from witnesses, noting location, times and dates. Use discretion when gathering information to protect the privacy of the employee in question.

 

Provide the employee with expected improvements and a deadline. Use your company handbook or policies as a guide to determine the appropriate disciplinary action for the offense. Include corrective actions that will be taken if the employee fails to make necessary changes.

 

Related: Cultivating Positive Workplace Behavior

 

Disciplinary form template

Use this template to create a disciplinary form:

 

Employee warning notice

Employee: [first and last name]

Date notice was received: [month/day/year]

Role: [employee’s position]

Supervisor/manager: [first and last name]

 

Violation (check one)

__[List of behaviors that would require disciplinary action]

 

Violation details

Date: [date of the incident]

Time: [if applicable]

 

Employer’s summary of events

[Employer’s comments]

 

Employee’s statement

[Employee’s comment]

 

Action taken

[Repercussions as outlined by company policy]

[Relevant dates]

 

Prior warnings:

[Warning number, date and action taken]

 

Statement of receipt

 

Employer and witness

 

“I have explained every detail regarding this violation of company policy and the resulting disciplinary action as well as any future actions that will be taken if this behavior continues. The employee has been given a copy for their records.”

 

Employer’s name:

Employer’s signature:

Title:

Date:

 

Witness’s name:

Witness’s signature:

Title:

Date:

 

Employee

 

“I understand the contents of this documentation and the disciplinary actions that result. I have received a copy of this notice and understand that a copy will be kept in my employee file.”

 

Employee’s name:

Employee’s signature:

Date:

 

Example of a completed disciplinary form

Here is an example of a filled out disciplinary action form:

 

Employee warning notice

Employee: Brent Kaiser

Date: 10/26/20

Role: Sales representative

Supervisor/manager: Alex Beaker

 

Violation:

Tardiness

 

Violation details

Date: 10/26/19

Time: 9:30 a.m.

 

Employer’s summary of events

Brent was late to work without providing an adequate reason or phone call to inform his supervisor.

 

Employee’s statement

My alarm didn’t go off this morning and so I overslept. I will take steps to ensure that this will not happen in the future.

 

Action taken

This is the first formal written notice. Future instances of tardiness within the next 90 days will warrant an employee review.

Valid until 01/26/2020

 

Prior warnings:

Verbal warning for tardiness – 9/15/19

 

Statement of receipt

 

Employer and witness

 

“I have explained every detail regarding this violation of company policy and the resulting disciplinary action as well as any future actions that will be taken if this behavior continues. The employee has been given a copy of their warning form.”

 

Employer’s name: Alex Beaker

Employer’s signature: Alex Beaker

Title: Sales manager

Date: 10/26/19

 

Witness’s name: Brenda Bates

Witness’s signature: Brenda Bates

Title: Sales supervisor

Date: 10/26/19

 

Employee

 

“I understand the contents of this documentation and the disciplinary actions that result. I have received a copy of this notice and understand that a copy will be kept in my employee file.”

 

Employee’s name: Brent Kaiser

Employee’s signature: Brent Kaiser

Date: 10/26/19

 

Disciplinary action FAQs

 

What constitutes disciplinary action?

Disciplinary action is necessary when an employee fails to satisfy established and communicated standards for performance or policies outlined in an employee handbook. The employee handbook also usually contains information about actions that will be taken when an expectation is violated. Some common reasons for disciplinary action are:

 

  • Tardiness
  • Absenteeism
  • Work performance
  • Disrespectfulness
  • Dress code violation
  • Inappropriate language
  • Policy or procedure violations

 

What are the different types of disciplinary action?

Organizations usually establish levels of disciplinary action based on the number of times the incident has been repeated within a certain time frame, such as each quarter. Common methods are:

 

 

Is it considered insubordination if an employee refuses to sign a disciplinary action form?

An employee might refuse to sign disciplinary action forms because they don’t agree with the warning. Though employees aren’t required by law to sign, it’s a good idea to get proof they have received the warning.

 

Include a line that states that the employee has received the warning but doesn’t agree, and provide a field for them to sign as an acknowledgment of receipt. If they continue to resist, ask them to prepare a dated and signed rebuttal and attach it to the disciplinary action form.

 

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Last updated: Jul 27, 2020