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Date of Meeting
Date and Time of Incident.
The purpose of this meeting is to inform you of a situation that requires documentation.
Nature of Incident.
Unsatisfactory Customer Service
Tardiness or Early Leave
Violation of Policy
Violation of Safety
Rudeness or Altercation w/ coworker or guest
Unsatisfactory Work Quality
Failure to Follow Intrustions
Personal tasks while at work
Great Customer Service
Above and Beyond
Specifics of situation:
Actions Taken Previously
Actions Taken Today
Consequences should incident occur again.
I have read and understand the details that were covered in this meeting.
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment;
or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is
permissible in your workplace or jurisdiction.
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