Farmrichfoods Meat Processing and Poultry Dressing Plant

Purok 3, Malamig, Bustos, Bulacan

RECORD OF DISCIPLINARY ACTION

Employee Name: Position:
Supervisor Name: Position:
Date: Incident Location:
Incident Time: Incident Date:

Description of Incident
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Witness Incident
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Was this incident in violation of a company policy? Yes No

If Yes, Specify which policy and how incident violated it.

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Name of those in attendance at current disciplinary action meeting:

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What action will be taken against the employee:

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Corrective or disciplinary action to be taken:

Verbal Written Probation Suspension Others (Specify below)

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(If on probation, period begins ___________ and ends ______________)

Consequences for failure to improve performance or correct behavior:

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Employee Statement:

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I acknowledge that I have read and understand the above information and consequences.

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Employee Signature Date

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Manager/Head Signature Date