Notice of Disciplinary Action Store NumberEmployee Name First Last Date of Notice Date Format: MM slash DD slash YYYY Type of Problem or Violation:TardinessAbsenteeismInsubordinationQuality of WorkQuantity of WorkNeatnessSafetyDrug or Alcohol AbuseCarelessnessOtherIf other:Date of Occurrence Date Format: MM slash DD slash YYYY Details of Occurrence (Include description of impact on Company):Corrective Action to be Taken:Suspension without PayVerbal WarningWritten WarningCounseling NoticeDocumentationFirst Day of Suspension Date Format: MM slash DD slash YYYY Last Day of Suspension Date Format: MM slash DD slash YYYY Expected Improvement (Include a clear statement as to the consequences of failing to improve):Employee's Statement (Use additional paper if necessary):By signing this notice, I am acknowledging that I have been counseled about my inappropriate conduct and informed of consequences if improvements are not made.Date Date Format: MM slash DD slash YYYY