Disciplinary Action Form

EMPLOYEE NAME: WORK LOCATION: DATE OF DISCIPLINING ACTION

GIVEN:

EMPLOYEE ID NUMBER: JOB TITLE/DESIGNATION: DEPARMENT/SBU:

1

Violation/Infraction Statement

Date of Violation: September 20, 2020 Place of Violation: DS Operations

Violation/Infraction Statement (Description):

Article 5. INFRACTIONS AGAINST PERFORMANCE OF WORK

Section 8. Non-observance of Standard Operating Procedures (SOP)

Any employee who violates or refuses or fails without justifiable reason to comply with the Company
Standard Operating Procedure (SOP) or other related or similar programs, plans, or other rules,
regulations, prescriptions, mandates and policies depending upon the gravity or frequency of the
infraction. – Type C

Disciplinary Action Taken (Please check)

 Verbal Warning
o Written Warning

o Suspension without pay 30 days: EFFECTIVE DATE: ______________________

Corrective Actions to be Taken

CorrectiveActionPlan/Time-frame: Issued Verbal Warning

Next Action Step if Problem Continues: Please be advised that if you are involved in any future

incidents of this nature, you may be subject to further disciplinary action up to and including
termination of employment.

I acknowledge receipt of this Disciplinary Action and that its’ contents have been discussed
with me and that I understand the same.

Employee Signature: ______________________________________ Date: _____________________
Immediate Head Signature: ______________________________ Date: _____________________

The above disciplinary action has been noted and this form will be made part of the above
employee’s 201 File, as of this date.