Disciplinary Action Form

Document employee policy violations, investigation findings, corrective action, and acknowledgment for follow-up.

Case Overview

• Date of case entry
• Reported by
  Name and title of the manager, supervisor, or HR representative documenting the case.
• Employee name
  Enter only the minimum necessary identifying information.
• Employee ID
  Optional internal identifier if used by your organization.
• Department
• Manager name

Policy Violation Details

• Date of incident
• Time of incident
• Type of violation
• Policy or rule referenced
  List the specific policy name or rule number, if applicable.
• Incident summary
  Provide a factual, objective summary of what occurred. Avoid opinions and unnecessary PII.
• Witnesses
  List only individuals directly relevant to the case.

Investigation Findings

• Was an investigation conducted?
• Investigation date
• Findings
• Evidence summary
  Summarize relevant evidence, such as statements, records, or system logs. Do not attach unnecessary PII.
• Was the violation substantiated?

Corrective Action

• Corrective action level
• Corrective action details
  State what action was taken, who approved it, and any deadlines or expectations.
• Required improvements
• Follow-up date
• Additional training required?
• Training details

Employee Acknowledgment

• Employee acknowledgment
• Employee comments
• Employee signature
• Manager/HR signature