SWF PIP - Performance Improvement Plan

• Employee Name

GENERAL INFORMATION

• Employee Name

• Date of Notice

  Date

PLAN DETAILS

• Frequency

  First Notice

  Second Notice

  Third Notice

  Ongoing

• Severity

  Select Verbal Warning Written Warning Dock Incentive or Bonus Disciplinary Probation Suspension Without Pay Separation

  • Verbal Warning
  • Written Warning
  • Dock Incentive or Bonus
  • Disciplinary Probation
  • Suspension Without Pay
  • Separation

• Start Date

  Date

• End Date (Return to Work Date)

  Date

• Amount

• Nature of Improvement Required

  Select Attendance Behavioral Performance Substance-Free Workplace Safety Other

  • Attendance
  • Behavioral
  • Performance
  • Substance-Free Workplace
  • Safety
  • Other

• Specifically

  Select Failure to Notify (No Call No Show) Excessive In-Late/Out-Early Excessive Absenteeism Violation of Meal/Break/Work Schedule Falsification of Time Records

  • Failure to Notify (No Call No Show)
  • Excessive In-Late/Out-Early
  • Excessive Absenteeism
  • Violation of Meal/Break/Work Schedule
  • Falsification of Time Records

• Details of Incident(s) - Please be as specific as possible

• Please attach any relevant photos or files

  Media

• Details of Improvement(s) Required - Please be as specific as possible

• Expected Completion Date

  Date

• Completed By

  Sign

• An employer witness was used for this conversation

• Employer Witness

  Sign

• Specifically

  Select Failure to Notify (No Call No Show) Excessive In-Late/Out-Early Excessive Absenteeism Violation of Meal/Break/Work Schedule Falsification of Time Records

  • Failure to Notify (No Call No Show)
  • Excessive In-Late/Out-Early
  • Excessive Absenteeism
  • Violation of Meal/Break/Work Schedule
  • Falsification of Time Records

• Details of Incident(s) - Please be as specific as possible

• Please attach any relevant photos or files

  Media

• Details of Improvement(s) Required - Please be as specific as possible

• Expected Completion Date

  Date

• Completed By

  Sign

• An employer witness was used for this conversation

• Employer Witness

  Sign

• Specifically

  Select Insubordination Theft of Any Kind Unprofessional Conduct Verbal Harassment Physical Harassment Sexual Harassment Misuse of Company Property

  • Insubordination
  • Theft of Any Kind
  • Unprofessional Conduct
  • Verbal Harassment
  • Physical Harassment
  • Sexual Harassment
  • Misuse of Company Property

• Details of Incident(s) - Please be as specific as possible

• Please attach any relevant photos or files

  Media

• Details of Improvement(s) Required - Please be as specific as possible

• Expected Completion Date

  Date

• Completed By

  Sign

• An employer witness was used for this conversation

• Employer Witness

  Sign

• Specifically

  Select Improper Stock Rotation Generally Unsatisfactory Performance Unsafe Job Performance Failure to Follow Instruction Instruction Sleeping On the Job Refusing Work Assignment

  • Improper Stock Rotation
  • Generally Unsatisfactory Performance
  • Unsafe Job Performance
  • Failure to Follow Instruction Instruction
  • Sleeping On the Job
  • Refusing Work Assignment

• Details of Incident(s) - Please be as specific as possible

• Please attach any relevant photos or files

  Media

• Details of Improvement(s) Required - Please be as specific as possible

• Expected Completion Date

  Date

• Completed By

  Sign

• An employer witness was used for this conversation

• Employer Witness

  Sign

• Specifically

  Select Reasonable Suspicion Post-Accident (DOT Only) Random (DOT Only)

  • Reasonable Suspicion
  • Post-Accident (DOT Only)
  • Random (DOT Only)

• Details of Incident(s) - Please be as specific as possible

• Please attach any relevant photos or files

  Media

• Details of Improvement(s) Required - Please be as specific as possible

• Expected Completion Date

  Date

• Completed By

  Sign

• An employer witness was used for this conversation

• Employer Witness

  Sign

• Specifically

• Details of Incident(s) - Please be as specific as possible

• Please attach any relevant photos or files

  Media

• Details of Improvement(s) Required - Please be as specific as possible

• Expected Completion Date

  Date

• Completed By

  Sign

• An employer witness was used for this conversation

• Employer Witness

  Sign

EMPLOYEE ACKNOWLEDGEMENT

• I have read and understand this notice. I am aware that further disciplinary action, up to and including termination of employment, may result if a similar incident occurs in the future.

• I AGREE with this notice.

• I DISAGREE with this notice.

• Employee disagreements will be taken into consideration but the details of the Improvement Plan remain in effect until/unless a written modification is issued from the employer.

• Employee explanation is required. Please include all relevant details.

• Employee

  Sign