DISCIPLINARY ACTION FORM

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

ATTENDANCE

Infraction:

Points:

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

OTHER VIOLATIONS

Description of Violation/Incident Details:
Plan for Improvement:

ACTION

Date suspended:
Start Date Suspension
End Date Suspension
CONSEQUENCE OF NEXT OFFENSE:
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
Date
Manager Signature
Date
Witness(upon refusal to sign)
Date
FOR PURCHASE OF SAFETY GLASSES: I expressly authorize Diamond Detail to deduct this amount from my wages:
Amount Due:
Employee Name
Employee Signature