Disciplinary Write-up

• Prepared by

• Associate Name:

• People Soft #

• Shift

  Select 1st Shift 2nd Shift 3rd Shift

  • 1st Shift
  • 2nd Shift
  • 3rd Shift

• Select date

  Date
• Location
  Address

VIOLATION

• Type of warning

  Select Verbal Warning Written Warning Serious Warning Other

  • Verbal Warning
  • Written Warning
  • Serious Warning
  • Other

• Explain:

• Picture of violation

  Media

• Violation Date & Time

  Date

SAFETY AND STANDARDS OPERATING PROCEDURES (check all that apply)

• Unsafe Act

  Safe

  At Risk

  N/A

• Failure to follow loading procedures.

  Safe

  At Risk

  N/A

• Failure to follow safety procedures

  Safe

  At Risk

  N/A

• Failure to follow picking procedures

  Safe

  At Risk

  N/A

• Failure to follow receiving procedures

  Safe

  At Risk

  N/A

• Working in unsafe conditions or improper housekeeping.

  Safe

  At Risk

  N/A

• Improper safety attire or failure to wear PPE.

  Safe

  At Risk

  N/A

• Failure to complete the MHE inspection.

  Safe

  At Risk

  N/A

• Failure to intervene or address an unsafe act of another.

  Safe

  At Risk

  N/A

• Other.

  Safe

  At Risk

  N/A

Violations of Company Conduct ( check all that apply )

• Working under the influence

• Dishonesty

• Lack of Productivity or failure to follow instructions

• Tardiness or Absenteeism

• Horseplay

• Other:

• Describe:

  Yes

  No

  N/A

Associate Statement (Check Proper Box)

• I agree with the violations identified in this report

• I disagree with the violations identified in this report because:

• Ask associate to respond.

  Yes

  No

  N/A

• Focus discussion on solution.

  Yes

  No

  N/A

• Associate Signature

  Sign

• Supervisor Signature

  Sign