[Company Name]
[Company Address]
[City, State, ZIP]
[Phone] | [Email]
Date: [Date]
To: [Employee Full Name]
Job Title/Department: [Title/Department]
Employee ID (Optional): [ID]
Work Location: [Location]
1. Purpose of This Letter
This letter serves as a ☐ written warning ☐ final written warning regarding insubordination and failure to follow reasonable instructions.
2. Incident Details (Facts)
2.1 Date/Time/Location. [Insert date/time/location.]
2.2 Instruction Given. On [Date], you were instructed to: [Describe instruction].
2.3 Employee Response. You responded by: [Describe refusal/behavior, including exact words if known].
2.4 Impact. [Operational, safety, customer, or team impact.]
3. Employee Explanation (If Provided)
3.1 You stated the reason for refusing was: [Reason given].
3.2 Company response/follow-up (if any): [Investigation, training, clarification].
4. Policy and Expectations
4.1 Policy/Standard Referenced. [Handbook section / conduct policy / job description.]
4.2 Expectations Going Forward. Effective immediately, you must:
-
Follow reasonable, lawful directions from supervisors
-
Communicate respectfully, even during disagreement
-
Raise concerns through proper channels (HR/manager)
-
Meet job duties and performance standards
Follow reasonable, lawful directions from supervisors
Communicate respectfully, even during disagreement
Raise concerns through proper channels (HR/manager)
Meet job duties and performance standards
5. Corrective Actions
5.1 Required Steps.
-
Meet with [Manager/HR] on [Date] to review expectations
-
Complete training/coaching on [Topic] by [Date]
-
Confirm understanding of instructions and policies in writing by [Date] (optional)
5.2 Follow-Up Review. Your conduct/performance will be reviewed on: [Date].
Meet with [Manager/HR] on [Date] to review expectations
Complete training/coaching on [Topic] by [Date]
Confirm understanding of instructions and policies in writing by [Date] (optional)
5.2 Follow-Up Review. Your conduct/performance will be reviewed on: [Date].
6. Consequences
6.1 Continued insubordination, refusal to follow instructions, or further policy violations may result in additional discipline up to and including termination, consistent with company policy and applicable law.
7. Employee Response (Optional)
7.1 Employee comments: [Space for response]
Signatures
Supervisor/Manager: [Name]
Title: [Title]
Date: [Date]
Signature: ___________________________
Employee Acknowledgment:
I acknowledge receipt of this warning. My signature does not necessarily indicate agreement.
Employee: [Employee Full Name]
Date: [Date]
Signature: ___________________________
If Employee Refuses to Sign (Optional):
Witness Name: [Name]
Date: [Date]
Signature: ___________________________