EMPLOYEE DISCIPLINARY NOTICE

Date:	_

Employee's Name: 	_

Department:  	_

Nature of Incident

 	Tardiness
 	 Absence
 	 Policy Violation

 	 Insubordination
	Unsatisfactory Performance
 	  Other

Date of Infraction: 	Time: 	

Place: 	_

Details of Incident and Action Taken: 	_

Number of Prior Warnings:	Verbal:  	_	Written: 	_

Department Head or Supervisor's  Signature 	Date

Employee's Comments: 	_

I have read and understand the contents of this disciplinary notice.

Employee's Signature

Date

Memo attached
The supervisor should initial here if
the employee refuses to sign this notice.

Northeastern Retail lumber Association 12/11