Employee Disciplinary Action Form

Employee Disciplinary Action Form

An employee disciplinary action form details an employee’s workplace violation and the punitive measures to be enforced. The form is completed to document the employee’s violation history, prior warnings, and the employee’s statement regarding the violation.

Last updated July 29th, 2025

An employee disciplinary action form details an employee’s workplace violation and the punitive measures to be enforced. The form is completed to document the employee’s violation history, prior warnings, and the employee’s statement regarding the violation.

  1. Home »
  2. Employee Forms »
  3. Write Up »
  4. Disciplinary Action

How to Discipline Employees

  1. Evaluate situation. Employers must ensure that the reason for disciplining is not discriminatory, retaliatory, or inconsistent with company policy.
  2. Prepare document. A form is often completed by the management to document the disciplinary action and avoid misunderstandings.
  3. Discuss decision. Employers will typically meet with the employee to go over the reasoning behind the disciplinary measure.

Sample

Download: PDF, MS Word, ODT

EMPLOYEE DISCIPLINARY ACTION FORM
Supervisor Name: [SUPERVISOR NAME]  Date: [MM/DD/YYYY]
EMPLOYEE INFORMATION

Employee Name: [EMPLOYEE NAME] Employee Department: [EMPLOYEE DEPARTMENT]
Employee Title: [EMPLOYEE TITLE]  Employee ID #: [EMPLOYEE ID #]

VIOLATION INFORMATION

This disciplinary action form is being issued due to the following violation:

Attendance
Tardiness
Harassment
Disobedience
 Performance
Theft/Damage
Safety
Conduct
Other: [OTHER]

When did the violation happen? [VIOLATION DATE]
Where did the violation happen? [VIOLATION LOCATION]
If there have been previous warnings for this violation, enter them here:
1st warning date: [MM/DD/YYYY] Written Verbal
2nd warning date: [MM/DD/YYYY] Written Verbal
3rd warning date: [MM/DD/YYYY] Written Verbal

STATEMENTS

Employer Statement: [EMPLOYER STATEMENT]
Employee Statement: [EMPLOYEE STATEMENT]

DISCIPLINARY ACTION

The following disciplinary action will be taken: [DISCIPLINARY ACTION]

Employee Signature:                                                               Date: ______________
Print Name: [EMPLOYEE NAME]

Company Signature:                                                               Date: ______________
Print Name: [REPRESENTATIVE NAME] Title: [REPRESENTATIVE TITLE]

Witness Signature:                                                               Date: ______________
(If employee refuses to sign) Print Name: [WITNESS NAME]