Record of Disciplinary Action
Employee Name Employee Title
Manager Name Manager Title
Today’s Date Incident Date
Incident Time Incident Location
Description of the incident that occurred:
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Witnesses to the incident (if applicable):
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Names of those in attendance at current disciplinary action meeting:
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Corrective or disciplinary action to be taken:
 Verbal  Written  Probation  Suspension  Other (explain below)
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Supervisor Signature Ngày
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