Simple Employee Write Up Form

Tuesday, June 27th 2017. | Sample Forms
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Simple Employee Write Up Form

Employee Name: _________________________________________
Employee ID: _________________________________________
Department: _________________________________________
Job Title: _________________________________________
Date of Write-Up: _________________________________________
Date of Incident: _________________________________________
Type of Disciplinary Action:
☐ Verbal Warning
☐ Written Warning
☐ Suspension ( ___ Days)
☐ Other: ______________________________

1. Description of Incident:
[Provide a clear, concise, and factual account of the incident or performance issue that led to this write-up. Include specific examples, dates, times, and any relevant details. Avoid making judgments or assumptions – stick to observable facts.]

2. Policy/Procedure Violated:
[List the specific company policy, procedure, rule, or expectation that was violated. If multiple policies were violated, list them all.]

3. Impact of Incident:
[Describe the impact of the employee’s actions. This could include impact on: ]
Client/Customer Relations:
Company Reputation:

4. Previous Discussions/Warnings:
[Indicate whether the employee has received prior verbal or written warnings for similar behavior or performance issues. Provide dates and summaries of previous discussions.]

5. Employee Explanation:
[Provide a space for the employee to provide a written explanation of the incident from their perspective. ]

6. Plan of Action:
[Clearly outline the specific steps that the employee is expected to take to improve their performance or address the issue. This could include:]
Performance Goals:
Behavior Modification:

7. Consequences of Further Incidents:
[Clearly state the potential consequences if the employee fails to meet the expectations outlined in the plan of action, or if similar incidents occur in the future. ]

8. Acknowledgements:
Employee Signature: ___________________________ Date: ______________
Supervisor Signature: ___________________________ Date: ______________
Employee Statement (Optional):
[The employee may use this space to provide any further comments or context regarding the write-up. ]

[Important Note: This form is a template and may need to be adapted to suit your company’s specific policies and procedures. Consult with your HR department or legal counsel to ensure compliance with all applicable laws and regulations. ]

Simple Employee Write Up Form :

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