DISCIPLINE NOTICE

Name of Employee: Notice Issued Date:

Position: Line Manager:

PART A

1. DISCIPLINARY MATTER(S)
A. What was/ were the offense(s) committed, check 1 or more box as appropriate:
Dishonesty like altering time sheet or falsification of report
Tardiness, absenteeism/ failure to report for work without notification
Disorderly, immoral conduct or indecency on company property
Leaving work before end of shift or not being ready to go to work at the start of the shift
Interfering with the work of other employees
Inefficiency/ failure to complete work assignment
Violation of or failure to observe work procedures
Failure to observe proper safety procedures
Contributing to unsanitary conditions or poor housekeeping
Malicious gossip or spreading humors or verbal abuse of another employee
Gambling on company property
Under the influence of and/ or possession of drugs or alcohol
Physical assault or instigating fighting on company property
Possession of deadly weapon
Willful destruction of company property
Stealing company property or getting “kickbacks” or receiving gift in exchange for a favor
Serious misconduct or willful disobedience or insubordination or refusal to perform assigned work
Gross and habitual neglect of duty
Fraud or willful breach of trust
Commission of a crime or offense against the employer, his family or representative
Other, specify: __________________________

B. When was/ were the offense(s) committed (date and time):

C. Where was/ were the offense(s) committed:

D. Who is/ are being charged of the offense(s):

E. Who is/ are the witness(es):

F. How was/ were the offense(s) committed:

2. ACKNOWLEDGMENT RECEIPT OF NOTICE

Signature over
Printed Name:
Date:
 DISCIPLINE NOTICE

Time:
3. WITNESS TO THE SERVICE OF NOTICE
Signature over
Printed Name:
Date:
Time:

Instruction to the Notice Server:

1) Fill-up Item 1: DISCIPLINARY MATTER(S), create 2 copies: company copy and employee copy;
2) Give 1 copy of the Discipline Notice to the subject employee;
3) Request him/ her to completely fill-up Item 2: ACKNOWLEDGMENT RECEIPT OF NOTICE on company’s copy of the Notice;
4) Fill-up and sign the Item 3: WITNESS TO THE SERVICE OF NOTICE on company’s copy, placing YOUR OWN NAME and
SIGNATURE;
5) However, if the employee refuses to sign, do not insist or argue. Leave a copy of the Notice on his/ her work workstation
a) Then fill-up and sign the ACKNOWLEDGMENT RECEIPT OF NOTICE of company’s copy, placing YOUR OWN NAME and
SIGNATURE with a note: “EMPLOYEE REFUSED TO RECEIVE”;
6) Return the company’s copy to the HR Manager to action on due process;
7) If the Notice cannot be delivered PERSONALLY to the subject employee, then you must send it to him/ her by way of registered
mail (with return card) using his/her last known address.

4. NOTICE TO EXPLAIN (BY THE EMPLOYEE)

Please submit your written explanation to the DISCIPLINARY MATTER(S) being charged against you
described or narrated in page 1 within FIVE (5) CALENDAR DAYS from the date that this Notice was
served to you. If more space is required, use back page.

MRCC (the “Company”) is considering a possible case/ disciplinary action against you, and for this reason you
are directed to submit a written explanation on the foregoing allegations which may lead to appropriate
disciplinary action which may include termination from service.

Failure to submit your written explanation within the deadline means you have waived your right to be heard and
management can make the appropriate course of action or decision.
 DISCIPLINE NOTICE

Kindly give this matter your priority attention.