Employee Discipline Form

Create Document

Employee Discipline Form

An employee disciplinary action form details an employee’s workplace violation and the punitive measures that will be taken. The form lists the employee’s previous violations leading up to the disciplinary action including all prior warnings. It is common for both employer and employee to provide statements of their respective sides of the story.

Create Document
PDF
Word
ODT

Last updated August 19th, 2025

Document Preview

An employee disciplinary action form details an employee’s workplace violation and the punitive measures that will be taken. The form lists the employee’s previous violations leading up to the disciplinary action including all prior warnings. It is common for both employer and employee to provide statements of their respective sides of the story.

Downloads: 14
  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. Discuss Decision – A meeting should take place between employee and employer where the employer can explain the reason for the proposed disciplinary action, how they would like them to improve, and what the consequences are for failing to meet the employer’s expectations.
  3. Document Incident – A disciplinary action form is completed if the employer proceeds with the action after hearing the employee’s version of the events.

Employees with Mental Health Issues

Employers should exercise care when disciplining employees with mental health issues (such as PTSD or depression), as statutes regarding workplace protections for disabilities can apply, provided the condition “substantially limits” activities.[1]​

In these cases, disciplinary action may be taken if other employees are held to the same standards and a policy consistent with the company’s needs is violated.[2]​

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 #]

INCIDENT INFORMATION

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

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

When did the incident happen? [INCIDENT DATE]
If there have been previous warnings for this issue/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 ☐

Description of Incident/Issue: [INCIDENT/ISSUE DESCRIPTION]

DISCIPLINARY ACTION

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

EMPLOYEE STATEMENT
Employee Statement: [EMPLOYEE STATEMENT]

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]

Sources

  1. 42 U.S.C. § 12102(1)(a)
  2. U.S. EEOC – Applying Performance and Conduct Standards