Disciplinary Notice Template

This Disciplinary Notice (“Notice”) is issued on [Date] by:

Employer:
Name/Company: __________________________
Address: __________________________
Phone: __________________________
Email: __________________________

Employee:
Name: __________________________
Department/Position: __________________________
Supervisor: __________________________

1. Nature of Violation

The following incident(s) or behavior(s) have been identified as violations of company policies or performance standards:
[Detailed description of incident, including dates, times, and relevant witnesses]

Policy violated: __________________________ (refer to handbook or policy document)

2. Previous Actions Taken

Prior steps to address this issue:
☐ Verbal warning given on [Date]
☐ Written warning issued on [Date]
☐ Coaching or counseling session on [Date]

3. Corrective Action Required

To resolve this issue, the Employee must take the following steps:
[List clear, measurable corrective actions expected of the employee]

Deadline for completion: [Date]

4. Consequences of Non-Compliance

Failure to meet the outlined expectations may result in further disciplinary actions, up to and including termination of employment.

5. Acknowledgment by Employee

The Employee acknowledges receipt of this Notice and understands its contents.
☐ I agree with the information presented.
☐ I disagree and have provided a written response.

Employee Signature: __________________________ Date: _________

6. Employer Signature

Supervisor/Manager Signature: __________________________ Date: _________
HR Representative Signature: __________________________ Date: _________

7. Additional Notes (Optional)

[Include any additional comments or supporting documentation, such as performance records or witness statements]