Employee Written Warning

1. Has a verbal warning been given?

• NoYes, the verbal warning was given on

2. Type of warning  

• First written warning
• Final written warning

3. Explain why this warning is being given (Additional information can be provided below).

• :
• :
• :
• :
• :
• :
• :
• :
• :
• :
• :
• :
• :
• :
• :
• :

5. Describe the change in behavior that is expected of the employee:

6. Describe the consequences if this behavior is not changed:

7. Employee statement or rebuttal:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

TO BE READ AND SIGNED BY THE EMPLOYEE:

The above problem(s) have been discussed with me, and I understand that failure to improve my performance or additional unsatisfactory behavior will result in further disciplinary action, up to and including suspension or termination. I understand that my signature does not necessarily signify agreement with the facts or actions stated. If I disagree, it is my option and responsibility to pursue an appeal as follows:

Employee's signature: ________________________________ Date: ____________________

-or-
Employee was asked to sign this written warning on   _______________   but declined to sign.

Witnessed by: ________________________________________ Date: ____________________
Name:
Title:

Supervisor's signature: _______________________________________ Date: _____________