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Employee Discipline Form
Date Time
*
MM
/
DD
/
YYYY
Employee Name
*
Last 4 SS Number
*
Checkbox
*
Attendance
Breach Of Company Policy
Carelessness
Creating a Disturbance
Failure to Follow Instructions
Insubordanation
Performance
Personal Work
Safety
Tardiness
Unauthorized
Work Quality/ Accuracy
Work Quantity/Output
Willful Damage To Company Property
Other
Description of Violation(s)
*
Employee Signature
*
Clear
Supervisor's Signature
*
Clear
