Incident Report Form

This is the Employee Disciplinary Report Form, Please fill this out and post it back in this section and I will review it with a Founder and we will decide action. Simply Copy the Form Fill it out and Repost it. If your wondering how to underline the words simply erase the already underlined and mark the U button at the top, as it will underline your words. Please fill out all parts, the Bottom Part is for OUR USE.

1. Name _______________ Date _______________________

Job Classification _________________________________________________________

Date of Hire _____________________ Supervisor _____________________________

2. Discipline Taken: Written Warning ___ Reprimand ___ Suspension ___ Discharge ___

Other ______________________________________________________________________

Reason (Attach screenies, if necessary): ____________________________

____________________________________________________________________________

Rule or Policy Violated: ___________________________________________________

____________________________________________________________________________

3. Prior Disciplinary Record: _____________________________________________________

____________________________________________________________________________


________________________________________________ ____________________________
Signature of Supervisor Date


________________________________________________ ____________________________
Signature of Personnel Director (Awensome) Date


________________________________________________ ____________________________
Signature of Owner or Founder Date


________________________________________________ _____________________________
Signature of Employee* Date
*BY SIGNING THIS DISCIPLINARY FORM, THE EMPLOYEE MERELY ACKNOWLEDGES THAT HE OR SHE
HAS READ IT, NOT THAT HE OR SHE AGREES WITH ITS CONTENTS.

Summary of Disciplinary Conference (to be completed by supervisor):

_____________________________________________________________________________________

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