Title Page
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Name
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Employee Number
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Department
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Job Title
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Conducted on
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Action to be taken
- Verbal Warning
- Writing Reprimand
- Suspension
- Dismissal
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Nature of Incident
- Unexcused Absence
- Tardiness
- Drinking on duty
- Reporting under the influence of intoxicants
- Reporting under the influence of controlled substances
- Garnishments
- Failure to follow instructions
- Dishonesty
- Leaving without permission
- Possession of weapons on company property
- Sexual Harassment
- Improper Conduct
- Insubordination
- Violation of safety rules
- Unsatisfactory work performance
- Destruction of company property
- Falsification of company records
- Theft (Stealing)
- Violation of company rules of conduct
- Other
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Supervisors Remarks
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Witness Name
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Employees Remarks
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Probationary Employee
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Supervisor
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Employee
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Offense Number
- First
- Second
- Third
- Fourth
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Last offense date
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Department Manager
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Additional Remarks (next reprimand)
