Verbal Warning
 Written Warning
 Suspension without Pay
1. Statement of the problem: (specific violation of rules, safety requirements, company practices or unsatisfactory performance.)
2. Prior discussion or warnings on this subject: (dates and whether oral or written.)
3. Identify the relevant company policy on this subject.
4. Summary of corrective action to be taken: (Include timeline for improvement and plans for follow-up.)
5. Employee comments (Employee does not have to agree with the Company’s actions, but the Employee is nevertheless required to follow the corrective action set forth herein):
Employee is warned that any further violations of company policy, safety rules, company practices or unsatisfactory performance will result in disciplinary action, up to and including termination of employment.
______________________________________________ __________ Employee Signature Date
______________________________________________ __________ Supervisor Signature Date
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