Disciplinary Action Form (The Scalo Companies)

• Employee Name

• Date

  Date

• Supervisor/Safety Department Member Name

Violation Section

• Select Type of Violation

  Select Safety Violation Performance Violation Policy Violation

  • Safety Violation
  • Performance Violation
  • Policy Violation

• Safety Violation Categories

  Select PPE Ladder/Scaffolding Set-Up/Loading/Hoist Housekeeping Tear Off Safety Tools/Equipment Fall Protection Kettle Safety Vehicle-Related Miscellaneous

  • PPE
  • Ladder/Scaffolding
  • Set-Up/Loading/Hoist
  • Housekeeping
  • Tear Off Safety
  • Tools/Equipment
  • Fall Protection
  • Kettle Safety
  • Vehicle-Related
  • Miscellaneous

• Safety Violation Comments/Details

• Performance Deficiency Categories

  Select Attendance Attitude Workmanship Necessary Tools Teamwork

  • Attendance
  • Attitude
  • Workmanship
  • Necessary Tools
  • Teamwork

• Performance Deficiency Comments/Details

• Policy/Conduct Violation Categories

• List Type of Policy/Conduct Violation

• Policy/Conduct Violation Comments/Details

Progressive Disciplinary Process

• Select Stage of Progressive Disciplinary Process

  Select Verbal - First Warning Written - Warning Written - Suspension Written - Termination

  • Verbal - First Warning
  • Written - Warning
  • Written - Suspension
  • Written - Termination

• Employee Signature

  Sign

• Date

  Date

• Employee Signature

  Sign

• Date

  Date

• Employee Signature

  Sign

• Date

  Date

• Supervisor/Safety Department Signature

  Sign

• Date

  Date