Disciplinary Action Form - Ecp

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Disciplinary Action Form
Employer: __________________________________________ Date: ________________________________
Employee Name: _____________________________________ SS#: _________________________________
Discipline Taken
Prior Dates of Discipline
Verbal Warning
_________ Verbal Warning
1st Written Warning
_________ 1st Written Warning
_________ 2nd Written Warning
2nd Written Warning
Suspension Pending Discharge
_________ Suspension Pending Discharge
Occurrences Resulting in Present Discipline
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Action Plan to Prevent Reoccurrences
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Employee* Signature: _____________________________________
Date: _________________
Supervisor Signature: ____________________________________
Date: _________________
Witness Signature : _____________________________________
Date: _________________
*If the employee refuses to sign this document, Manager needs to write on the above line that the Employee refused to sign.
Also, make a copy for the disciplined Employee that includes signatures.
Employers Choice Plus 7593 Tylers Place Blvd., West Chester, OH 45069 513-755-7719
Disciplinary Action Form
Employer: __________________________________________ Date: ________________________________
Employee Name: _____________________________________ SS#: _________________________________
Discipline Taken
Prior Dates of Discipline
Verbal Warning
_________ Verbal Warning
1st Written Warning
_________ 1st Written Warning
_________ 2nd Written Warning
2nd Written Warning
Suspension Pending Discharge
_________ Suspension Pending Discharge
Occurrences Resulting in Present Discipline
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Action Plan to Prevent Reoccurrences
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Employee* Signature: _____________________________________
Date: _________________
Supervisor Signature: ____________________________________
Date: _________________
Witness Signature : _____________________________________
Date: _________________
*If the employee refuses to sign this document, Manager needs to write on the above line that the Employee refused to sign.
Also, make a copy for the disciplined Employee that includes signatures.
Employers Choice Plus 7593 Tylers Place Blvd., West Chester, OH 45069 513-755-7719

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