EMPLOYEE REPRIMAND

• Audit Title

• Conducted on

  Date

• Prepared by

EMPLOYEE NAME

DESIGNATION

LENGTH OF SERVICE

TIME IN CURRENT POSITION

THE FOLLOWING ARE BRIEF STATEMENTS OF EMPLOYEE'S ACTION(S) GIVING CAUSE FOR THIS WRITTEN REPRIMAND AND SUGGESTED ACTION(S) FOR AVOIDING ANY RECURRENCE IN THE FUTURE.

WHAT IS EMPLOYEE BEING REPRIMANDED FOR? (GIVE DETAILS OF INCIDENT(S) REQUIRING THIS DISCIPLINARY ACTION)

WHAT POLICY/PROCEDURE OR OTHER CONDUCT RULE HAS BEEN VIOLATED

IF CONDUCT IS REPEATED OR OTER DISCIPLINARY PROBLEMS DEVELOP, WHAT ADDITIONAL ACTION WILL LIKELY TAKE PLACE

SUPERVISOR- RESTATE FOR THE EMPLOYEE'S BENEFIT, THE EXPECTED PERFORMANCE STANDARDS WHICH MUST BE MET IN ORDER TO CORRECT THE PROBLEM

• HAS EMPLOYEE BEEN WARNED ABOUT THIS BEFORE

  Yes

  No

  N/A

IF YES, WRITTEN OR VERBAL. BY WHOM AND WHAT DATE

• SUPERVISOR SIGNATURE

  Sign

EMPLOYEE COMMENTS

MY SIGNATURE HEREUPON DOES NOT NECESSARILY SIGNIFY MY AGREEMENT WITH THE ABOVE, BUT ATTESTS THAT I HAVE READ AND UNDERSTAND THE SERIOUS NATURE OF THIS REPORT. A REPETITION OF THIS ACTION OR OTHER ACTS OF A SIMILAR NATURE MAY RESULT IN A MORE SERIOUS CORRECTIVE ACTION AND/OR TERMINATION OF EMPLOYMENT

• EMPLOYMENT SIGNATURE.

  Sign