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Disciplinary Warning

Date:

Employee:

Position:

Date of Incident:

Incident:

Reason for Notice:

Action taken on this notice:

[ ] First Warning - Verbal

[ ] Second Warning - Written

[ ] Suspension for [--] days

[ ] Other (specify):

Next step for repeated infraction:

[ ] Second Warning - Written

[ ] Suspension for [--] days

[ ] Other (specify):

Supervisor Comments:

Employee Comments:

Signature

Date:

Supervisor

Signature

Date:

Employee