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Employee disciplinary action form template

Employee Disciplinary Action Form

Employee Information:

  • Employee Name:

  • Employee Position:

  • Department:

  • Supervisor:

Description of Incident:

  • Date of Incident:

  • Time of Incident:

  • Location of Incident:

  • Description of Incident:

Previous Discussions:

  • List previous discussions regarding performance issues or policy violations with the employee, including dates and details of the discussions.

Policy Violation:

  • Identify the specific policy that was violated.

Disciplinary Action:

  • Describe the disciplinary action that will be taken, such as verbal warning, written warning, suspension, or termination.

  • Provide a clear explanation of the consequences of the disciplinary action, including any timeline for improvement, if applicable.

Plan of Action:

  • Identify any specific actions the employee needs to take to improve their performance or comply with company policies.

  • Provide a timeline for the employee to take these actions.

  • Identify any resources or support that will be provided to the employee.


  • Provide space for the employee to acknowledge receipt of the disciplinary action form.

  • The employee should also have the opportunity to provide comments or concerns regarding the disciplinary action.


  • The employee and their supervisor should sign and date the form, indicating their agreement to the disciplinary action and the plan of action.


  • Emphasize that the disciplinary action is intended to help the employee improve their performance and comply with company policies.

  • Provide an opportunity for the employee to ask questions or provide feedback on the disciplinary action.

Thank you for your cooperation and commitment to improving your performance and complying with company policies. We hope that this disciplinary action will help you reach your full potential and continue to contribute to our organization. Sincerely, [Supervisor's Name]

[Supervisor's Title]


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