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Record of Disciplinary Action
Employee Name Employee Title
Manager Name Manager Title
Today’s Date Incident Date
Incident Time Incident Location
Description of the incident that occurred:
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Witnesses to the incident (if applicable):
__________________________________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
Names of those in attendance at current disciplinary action meeting:
__________________________________________________________________________________
__
__________________________________________________________________________________
__
__________________________________________________________________________________
__
Corrective or disciplinary action to be taken:
Verbal Written Probation Suspension Other (explain below)
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