Written Warning Discipline Notice

WRITTEN WARNING DISCIPLINE NOTICE

Employee’s Name__________________________________ Date______________________

Department _______________________________________ SS#______________________

Date of Incident____________________________________ Date of Hire_______________

Verbal

Written Warning

Suspension #_______Working Day(s) From______Through______

Discharge Effective________

Reason for warning of discipline. (Check one or more box as appropriate. Explain fully in Remarks Section.)

1. Violation of or failure to observe:

6. Failure to observe proper safety procedures

7. Failure to complete work assignment

8. Discourtesy or verbal abuse of guest or other employee

9. Damage or misuse of college property

10.Unauthorized removal from college premises of department or other property

11.Physical or verbal assault and/or fighting

12.Other (specify in remarks section)

Remarks: Explain reasons for warning or discipline, including specific details of incident or

violation; include prior warning(s).

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

I hereby acknowledge receipt of a copy of this discipline form.

____________________________________ ____________________________________

Employee’s Signature Date Supervisor Date

______________________________________

Department Director or Chair Date

cc: Department

Employee’s Master Personnel

File Employee