HTML Preview Disciplinary Report Of Conference page number 1.
Disciplinary Report of Conference
The purpose of this form is to document disciplinary actions. This form will be filed in the employee’s personnel record. It
will be removed if no further disciplines have occurred within a 12-month period from the date of this infraction.
Progressive disciplinary policy can be reviewed at: http://www.luc.edu/hr/policies/policy_progdiscipline.shtml
Employee Information:
Employee Name: Employee ID #:
Job Title:
Dept. #:
Ext: Home #:
Supervisor: Ext:
Discipline Information: (to be completed by supervisor or appropriate authority)
I. Date and time of current infraction:
II. Description of Infraction: Provide specific and detailed information of the circumstances
surrounding the infraction. Attach additional sheets if necessary:
II
I. Witnesses or others involved in the incident:
Name:
Name:
IV.
Employee may attach comments to this form within 15 days of receipt of discipline information.
Discipline Record:
List dates, level and reason for any disciplines, including oral warnings, on record.
Date: Level: Reason:
Date: Level: Reason:
Date: Level: Reason:
Recommended Level of Discipline:
1. Oral Warning: (for department records only)
2. Written Warning:
3. Suspension:* from to
4. Suspension pending termination:* (date)
*must be reviewed by HR
Si
gnatures:
Supervisor: Date:
Employee: Date:
(signature indicates receipt of information and does not indicate agreement)
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
HR is available to consult with supervisors in advance of any formal discipline action. Review and approval by HR is required
of all suspensions and terminations.
Approval Disallowed Reduced Comments:
Human Resources: Date:
-- PROVIDE: One copy for department files // one copy to employee // original with documentation to Human Resources --