Kembla Watertech Disciplinary Warning

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Company Information

• Select date

  Date

• Supervisors name

• Location

Employee Information

• Photo of employee

  Media

• Employee Name

• Position

Warning Report

• What is the nature of the warning?

  First Warning

  Second Warning

  Third Warning

  Immediate Dismissal

• Other please specify

Type of Violation

• Type of Violation

  Select Alcohol/Substance Abuse Sexual Harassment Workplace Violence Interpersonal Conflict Property Damage Safety Breach

  • Alcohol/Substance Abuse
  • Sexual Harassment
  • Workplace Violence
  • Interpersonal Conflict
  • Property Damage
  • Safety Breach

• If other please specify

Description of violation

• Description of Violation

Workers Statement

• Does the worker employee agree with the above?

  Yes

  No

  N/A

• Select date

  Date

• If not why?

• Employees signature

  Sign

• Supervisors signature

  Sign