![]() ![]() Step 7 – Section 7 – Employee Statement Regarding Facts Of Incident – Completed By (name of supervisor, manager or whomever is entrusted to oversee the employee during their work shift).If there is not enough space in the block provided, attach a separate sheet with the report, fully explaining the consequences.Provide an explanation, that will be or has been discussed with the employee, with regard to the consequences if there is a repeat occurrence of said infraction/violation.Step 5 – Section 5 – Consequence If Incident Occurs Again – If there were other actions taken in the past, in the block to the right of the lines provided, indicate whether or not there were written reports for past incidents by circling yes or no next to each line description.Details (explain the details of past actions taken).In this section identify past disciplinary actions in the blocks as follows: Step 4 – Section 4 – Past Disciplinary Action – If all of the information will not fit into the block on the form, attach a separate sheet with all information included for the purpose of explanation and legal documentation.Be certain to include the information that will be discussed with the employee and reasons why the write-up was necessary.Write a narrative discussing the facts of the incident that had occurred to have warranted an employee write-up.Select the offense(s) for which the employee is being warned and check the appropriate lines pertaining to the offense(s).Location ( of the business in which the infraction/violation occurred).Supervisor (name of supervisor implementing the write-up).Department (in which the employee is assigned or in which the infraction/violation occurred).Step 1 – Section 1 – Employee Information – Complete as follows: These documents are usually placed in an employee’s records for further evaluation at a later date. An employer will usually allow 2 or more write-ups prior to consideration for termination. Generally this is a form that allows the employer to counsel with the employee as well, to provide documentation that the employer has provided ample opportunity for the employee to make appropriate changes in order to remain employed. Download the Employee Write-Up Form which is a disciplinary report document used to warn or terminate an employee according to their actions. ![]()
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