Employee Discipline Notice

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Employee's Name

• Date of Warning

• Project

• Issued by

• Type of Violation

  Safety

  Other

• Company Statement (supervisor's report)

• Supervisor

  Sign

Employee Statement (check appropriate statement)

• I agree with the Company's statement:

• I disagree with the Company's statement for the following reasons:

• I have entered my statement of the above matter:

• Employee

  Sign

• Witness

  Sign

• I would like to receive a copy of this statement for my records: