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Disciplinary Action Incident Report -
Civil Service Employees
Labor and Employee Relations
Southern Illinois University Carbondale
Name of Employee
Job Classification
Department
State exactly what originally happened; when it happened, who was involved; witnesses; what rule, policy, statute or contract clause is
involved.
Action Recommended by the Department Head
In determining the recommendation for disciplinary action, the employees' previous behavioral problems, past performance and length of
service will be taken into consideration. (See the next page for guidelines)
Verbal Warning Only
(1)
Written Reprimand
(2)
(3)
(4)
Other
(Note: No action is to be taken until a review has been made by Labor and Employee Relations)
Signature of person preparing report Date
Signature of Department head Date
Employee Remarks
Signature of Employee Date
(The signature of the employee acknowledges receipt of this form; it does not mean agreement with its content.)
Disposition and Distribution of this Form:
(1) The original must be sent to Labor and Employee Relations as soon as possible in order that any action taken will be timely. Written record of any action taken, unless
it is a verbal warning only, shall be placed in the employee's official record which is maintained in Human Resources.
(2) A copy is to be retained by the employee's department. It will serve as documentation of a verbal or written reprimand.
(3) A copy is to be given to the employee at the time the form is completed.
Work Day(s) Suspension
LER Use Only
D/A Related