Z:\Forms\Written Warning Discipline Notice.doc 10/23/2003
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:
a. College and/or work rules
b. Work procedures
2. Insubordination
3. Tardiness, absenteeism, failure to report for work
4. Under the influence of and/or possession of drugs or alcohol
5. Dishonesty
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).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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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