Employee Write-Up (Disciplinary Action) Form Template

Employee Write-Up (Disciplinary Action) Form

1. 1. 1. Employee and Incident Information

   Employee name: [EMPLOYEE FULL NAME]. Employee ID: [EMPLOYEE ID]. Job title: [JOB TITLE]. Department: [DEPARTMENT]. Supervisor: [SUPERVISOR NAME AND TITLE]. Date of hire: [HIRE DATE]. Date of this notice: [DATE OF NOTICE]. Date of incident: [INCIDENT DATE]. Time of incident: [INCIDENT TIME]. Location of incident: [INCIDENT LOCATION]. Witnesses, if any: [WITNESS NAMES AND TITLES]. Was the employee interviewed before this notice was issued? [YES / NO]. Date of that discussion: [DISCUSSION DATE].

2. 2. 2. Level of Disciplinary Action

   This notice constitutes the following step in the progressive discipline process: [ ] Documented verbal counseling. [ ] First written warning. [ ] Second written warning. [ ] Final written warning. [ ] Suspension, [PAID / UNPAID], from [SUSPENSION START DATE] to [SUSPENSION END DATE]. [ ] Termination of employment effective [EFFECTIVE DATE]. Category of issue: [ ] Attendance or punctuality. [ ] Job performance or quality of work. [ ] Conduct or behavior. [ ] Safety violation. [ ] Policy violation. [ ] Insubordination. [ ] Other: [DESCRIBE]. Note whether this step follows the normal sequence or skips ahead, and if it skips ahead, state the reason: [REASON FOR ACCELERATED STEP, e.g., severity of the safety violation].

3. 3. 3. Description of the Incident

   Describe what happened in specific, observable terms, including dates, times, quantities, and direct quotations where relevant. Avoid conclusions about attitude or motive and record only what was seen, heard, or measured. [FACTUAL DESCRIPTION OF THE INCIDENT OR PERFORMANCE SHORTFALL]. Impact on the business, coworkers, customers, or safety: [DESCRIBE THE CONSEQUENCE, e.g., the shipment missed its delivery window, two coworkers had to cover the shift, a customer complaint was filed on (DATE)]. Supporting documentation attached: [ATTACHMENTS, e.g., timecard records, email thread dated (DATE), incident report, quality audit results, customer complaint].

4. 4. 4. Policy, Standard, or Expectation Involved

   The conduct described above did not meet the following documented standard: [POLICY NAME AND SECTION NUMBER, e.g., Employee Handbook Section 4.2, Attendance and Punctuality] or [PERFORMANCE STANDARD, e.g., the accuracy target of 98 percent set in the (DATE) performance review]. The employee received this standard on [DATE STANDARD WAS COMMUNICATED] by [METHOD, e.g., handbook acknowledgment signed on (DATE), onboarding training on (DATE), team meeting on (DATE)]. Quote the relevant language of the policy or standard here so the employee can see exactly what is being applied: [QUOTED POLICY OR STANDARD LANGUAGE].

5. 5. 5. Prior Warnings and Discipline History

   The following prior discussions or disciplinary actions relate to the same or similar conduct. Prior action 1: [DATE] — [TYPE, e.g., verbal counseling] — [SUBJECT] — issued by [SUPERVISOR NAME]. Prior action 2: [DATE] — [TYPE] — [SUBJECT] — issued by [SUPERVISOR NAME]. Prior action 3: [DATE] — [TYPE] — [SUBJECT] — issued by [SUPERVISOR NAME]. If there is no prior related discipline, state: "No prior disciplinary action on this subject." Note whether prior actions remain active under the company's record retention or rollover policy: [ACTIVE / EXPIRED AS OF (DATE) UNDER POLICY (SECTION)].

6. 6. 6. Corrective Action Plan and Expectations

   To meet expectations, the employee must do the following. Required action 1: [SPECIFIC, MEASURABLE ACTION] by [DEADLINE]. Required action 2: [SPECIFIC, MEASURABLE ACTION] by [DEADLINE]. Required action 3: [SPECIFIC, MEASURABLE ACTION] by [DEADLINE]. Support the company will provide: [SUPPORT, e.g., retraining on (SYSTEM) scheduled for (DATE), reassignment of (TASK) during the improvement period, weekly check-in with (SUPERVISOR NAME) each (DAY)]. The improvement period runs from [START DATE] to [REVIEW DATE]. Progress will be reviewed on [REVIEW DATE] and the outcome documented. Standards must be sustained after the review period, not only during it.

7. 7. 7. Consequences of Further Violations

   The employee is advised that failure to meet the expectations set out above, or a further violation of the same or a related policy, may result in additional disciplinary action up to and including termination of employment. [IF THIS IS A FINAL WRITTEN WARNING: This is a final written warning. Any further violation of this policy, or failure to meet the corrective action plan by (REVIEW DATE), will result in termination of employment.] Nothing in this notice alters the at-will nature of the employment relationship where applicable, and the company reserves the right to determine the appropriate level of discipline based on the circumstances of any future incident.

8. 8. 8. Employee Statement

   The employee is given the opportunity to respond in writing. Anything written here will be retained with this notice in the personnel file. Employee comments: [EMPLOYEE STATEMENT — provide at least ten blank lines on the printed form]. Does the employee dispute the facts described in Section 3? [YES / NO]. If yes, summarize the dispute: [SUMMARY]. Does the employee request review by human resources? [YES / NO]. If the employee declines to provide a statement, note that here: [DECLINED / PROVIDED SEPARATELY ON (DATE)].

9. 9. 9. Acknowledgment and Signatures

   Employee acknowledgment: My signature confirms that this notice was discussed with me and that I received a copy. It does not necessarily indicate that I agree with its contents. Employee signature: ______________________. Printed name: [EMPLOYEE FULL NAME]. Date: [DATE]. Supervisor signature: ______________________. Printed name: [SUPERVISOR NAME]. Title: [TITLE]. Date: [DATE]. Human resources review: ______________________. Printed name: [HR REPRESENTATIVE NAME]. Title: [TITLE]. Date: [DATE]. If the employee refuses to sign, the supervisor notes: "Employee declined to sign on [DATE] in the presence of [WITNESS NAME]." A refusal to sign does not invalidate the notice.

10. 10. 10. Human Resources Use Only

    Date received by human resources: [DATE]. Reviewed by: [HR REVIEWER NAME]. Consistency check completed: [YES / NO] — confirm that comparable conduct by other employees has been handled at a comparable level of discipline, and note any differences and their justification: [NOTES]. Copy filed in personnel file on [DATE]. Copy provided to employee on [DATE] by [METHOD]. Follow-up review scheduled for [REVIEW DATE] and assigned to [OWNER]. Outcome of follow-up review: [ ] Expectations met, no further action. [ ] Partial improvement, extend to (DATE). [ ] Expectations not met, escalate to (NEXT STEP). Reviewer notes: [NOTES].

11. 11. Disclaimer

    This template is provided for general informational purposes only and is not legal advice. Disciplinary documentation intersects with wage and hour rules on unpaid suspensions of exempt employees, with protections for concerted activity, protected leave, disability accommodation, and whistleblowing, and with union contract grievance procedures where a collective bargaining agreement applies. Applying progressive discipline inconsistently across employees is one of the most common sources of discrimination claims. Have counsel or an experienced HR professional review your discipline policy and this form before adopting it, and review individual cases involving protected activity before issuing a notice. Use of this template does not create an attorney-client relationship with ScanContract.