Employee Warning Report

EMPLOYEE WARNING REPORT
Employees receiving this warning report are hereby put on notice of a violation of the Town’s rules
and/or standards of employee conduct. Further violation(s) may result in further discipline, including
the
p
ossible termination of em
p
lo
y
ment.
Employee’s Name ____________________________________ Date ____________________________
Co
py
Forwarded to: Em
p
lo
y
ee Re
p
resentative Em
p
lo
y
ee Other:
VIOLATION
___ Attendance ___ Carelessness ___ Insubordination
___ Lateness/Ea rl y Quit ___ Violatio n of Company ___ Violatio n of Safety Pol i ci e s
Policies or Procedures
___ Unauthorized Absence ___ Willful Damage to ___ Working on Personal
From Work Area Material/Equipment Matters/Conflict of Interest
___ Substandard Work Quality ___ Threatening or Engaging ___ Unsatisfactory Behavior Towards
in Violence Employees or Customers
___ Drinking/Drugs While at Work ___ Unfit for Duty ___ Other: _______________________
EMPLOYER’S STATEMENT EMPLOYEE’S STATEMENT
Violation Date ____________ Time _________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
__ I agree with Employer’s Statement
__ I disagree with Employer’s description of violation for these reasons:
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
PREVIOUS WARNINGS
SUPERVISOR
__________________
__________________
__________________
OTHER
____________
____________
____________
WRITTEN (Y/N)
_____________
_____________
_____________
ORAL (Y/N)
____________
____________
____________
DATE
____________
____________
____________
ACTION TIMETABLE FOR IMPROVEMENT
___ Warning ___ Suspension ___ Dismissal
___ Other:
____________________________
___ Immediate ___ 30 days ___ 60 days
___ Other:
_______________________________
CONSEQUENCES
___ I HAVE READ THIS EMPLOYEE WARNING REPORT AND UNDERSTAND IT. ___ EMPLOYEE DECLINES TO SIGN
Failure to Improve will result in: ___ Warning ___ Suspension ___Dismissal ___ Other: _________________________________
____________________________ ____________ _______ _______ _________________________ _______________ ______________
Employee Acknowledgement of Receipt Date Supervisor Signature Date
**ORIGINAL TO BE PLACED IN PERSONNEL FILE**
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