EMPLOYEE WARNING NOTICE
NAME:
DEPT:
DATE OF INFRACTION:
POSITION:
DATE OF WARNING:
DATE HIRE:
TYPE OF INFRACTION: FAILURE TO FOLLOW
(A) INSTRUCTION OF SUPERVISOR
(B) COMPANY POLICY
REGARDING:
CORRECTIVE ACTION TO BE TAKEN:
CONSEQUENCES:
FUTURE FAILURE TO FOLLOW THIS OR ANY OTHER COMPANY POLICY OR REGULATION,
SUPERVISOR INSTRUCTION OR WILLFUL DISREGARD OF THE WARNING WILL RESULT IN
FURTHER DISCIPLINARY ACTION, UP TO & INCLUDING TERMINATION.
I have read & understand this warning given to me. Although I may not agree with it, my signature is
merely an acknowledgment that I have been counseled.
Employee Signature: ________________________________________ Date _______________________
Supervisor Signature: _______________________________________ Date _______________________
Witness Signature ________________________________________ Date _______________________
*(If employee refuse to sign)
INITIAL IF REFUSE TO SIGN ______