Disciplinary Notice



Employee______________________________________________

Department_____________________________________________

_____ Written Warning _____ Final Warning

1. Statement of the problem:______________________________________

___________________________________________________________

___________________________________________________________
2. Prior discussion or warnings on this subject, wherther oral or
written:_____________________________________________________
___________________________________________________________

3. Company policy on this subject:________________________________

___________________________________________________________

___________________________________________________________
4. Summary of corrective action to be taken by the Company and/or
employee:___________________________________________________

___________________________________________________________

5. Consequences of failure to improve performance or correct
behavior:______________________________________________________

_____________________________________________________________

6. Employee Statement:____________________________________________

_____________________________________________________________
_____________________________________________________________

Employee Signature: ___________________________________Date_______
Management Approval: __________________________________Date______

Distribution: One copy to Employee, one copy to Supervisor and original to Personnel File.