Employee warning notice

Employee name _____________________________________________

Type of violation
Attendance
Lateness/leaving early
Rudeness to employees/customers
Unsatisfactory work quality
or procedures

Carelessness
Failure to follow instructions
Willful damage to material/equipment
Violation of company policies

Previous warnings (Please note the date.)

Oral
___________________
1st warning
___________________
2nd warning
___________________
3rd warning

Employer statement
Date of incident _________ Time _________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________

Written
___________________
___________________
___________________

Insubordination
Violation of safety rules
Working on personal matters
Other: ___________________

Delivered by whom?
___________________
___________________
___________________

Employee statement

I agree with my employers statement

I disagree with my employers description of the violation.
The reasons are ____________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Action to be taken:
Warning

Probation
Suspension
Dismissal
Other________________________________________________________________________________________________
Corrective action to be taken:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Consequences should incident occur again:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
I have read this Employee Warning Notice and understand it.
Signature of employee ___________________________________________________

Date: _______________________

Signature of supervisor who issued warning ________________________________

Date: _______________________