DISCIPLINE DOCUMENTATION NOTICE	
Employee Information	
Name:      	
Job Title:      	
Department:      	
Incident Information	
Date/Time:      	
Place:      	
Description:      
	
Witnesses:      	
Was this incident a violation of a company policy? 	 Yes	 No
Standard operating procedure?	 Yes	 No
A management order?	 Yes	 No

If yes, specify which policy or procedure and how the incident violated it.      
	
Next Steps	
What actions have been taken in the past when incidents like this occurred?      

What action will be taken against this employee?      

Has the problem with the employee’s actions been discussed with the employee? 	 Yes	 No	
Did the employee offer any explanation for the incident?  Explain.      

Signature of manager preparing report:      	
Date:      	
Any employee rebuttal: