Discipline Documentation Form
EMPLOYEE INFORMATION
Employee’s Name
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Employee’s Job Title:
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INCIDENT INFORMATION
Date/Time of Incident:
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Location of Incident:
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Description of Incident:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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Witnesses to Incident:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Was this incident in violation of a company policy? _____ No _____Yes
If yes, specify which policy and how the incident violated it.
________________________________________________________________________________
________________________________________________________________________________
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ACTION TAKEN
What action will be taken?
________________________________________________________________________________
________________________________________________________________________________
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Has the impropriety of the employee’s actions been explained to the employee?
_____ Yes _____No
Did the employee offer any explanation for the conduct? If so, what was it?
_________________________________________________________________________
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Signature of person preparing report:
_________________________________________________________________________
Date: _____/_____/_____