S3H INC. Discipline Warning-Written-Notice-Term for Cause

• Name of Employee - Employee Write Up - Supervisor

• Written on:

  Date

• Jobsite:

• Location (Drop Pin for GPS & Address):
  Address

VIOLATION

• Employee name:

• Employee Photo:

  Media

• Supervisor name

• Type of Problem or Violation:

  Select Tardiness Unauthorized absence Insubordination Quality of Work Carelessness Drug or Alcohol Use Safety Violation Harassment Violation of Company Policy Willful Damage of company Property Other

  • Tardiness
  • Unauthorized absence
  • Insubordination
  • Quality of Work
  • Carelessness
  • Drug or Alcohol Use
  • Safety Violation
  • Harassment
  • Violation of Company Policy
  • Willful Damage of company Property
  • Other

• Please explain:

• Violation Date & Time

  Date

• Details of occurrence:

• Type of warning

  Verbal Warning

  Written Warning

  Other

• Picture of violation, behavior or other if applicable:

  Media

ACTION

• Action taken:<br>

  Verbal Warning

  Written Reprimand

  Termination for Cause

• Corrective action plan (Include a clear statement as to consequences for failing to improve).

• Deadline for improvement

  Date

Employee Statement (Check Proper Box)

• I agree with the details identified in this report

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

• Please explain:

• Employee Signature:

  Sign

• Employee statement:

Approvals

• Yes

  No

  N/A

• Safety Rep:

  Sign

• Was this a safety based infraction?

  Yes

  No

• Foreman:

  Sign

• Superintendent:

  Sign

• Division:

  Local 88

  Local 525