MEMO FOR: (insert name)

FROM: (Supervisor’s name/ Department Head)

RE: NOTICE TO EXPLAIN
DATE: ___________________

It has come to our attention that on ________, you defied _______ (state the
particular acts or omissions constitutive of insubordination)

As you know, Article _____, of the Company’s Personnel Policies states:

(insert applicable provision/s of the Company Rules, should

there be any)

Your acts may constitute not only a violation of the above-quoted provision but
may likewise amount to insubordination in accordance with the provisions of the Labor
Code.

You are, therefore, given five (5) days from receipt hereof to explain in writing
why no disciplinary action should be taken against you, including possible termination
from service, for the acts earlier described.

Moreover, your refusal to submit a written explanation within the time provided
herein will be construed as a waiver of your opportunity to be heard and explain your
side. The Company will then proceed with its investigation and shall render its decision
based on the documents at hand and evidence gathered.

Please give this matter your most preferential attention.

_________________________
(Supervisor/Department Head)

Received by:__________________
Date:_________________________