DISCIPLINARY ACTION FORM

Employee Name
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Manager Name
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Position/Location
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Date of Action
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Date of Offense
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ATTENDANCE

Infraction:

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Points:

Total-Points
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Points:0
Accumulation of Points
Total Overall Points
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OTHER VIOLATIONS

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Description of Violation/Incident Details:
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Plan for Improvement:
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ACTION

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Date suspended:
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Start Date Suspension
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End Date Suspension
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CONSEQUENCE OF NEXT OFFENSE:
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The above has been discussed with me by my supervisor. I understand the contents and acknowledge and understand the corrective action required. I also acknowledge and understand the potential consequences of noncompliance.
Employee Signature
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Date
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Manager Signature
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Date
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Witness(upon refusal to sign)
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Date
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FOR PURCHASE OF SAFETY GLASSES: I expressly authorize Diamond Detail to deduct this amount from my wages:
Amount Due:
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Employee Name
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Employee Signature
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