EMPLOYEE INCIDENT AND DISCIPLINE DOCUMENTATION FORM

Employee Information

Employee Name Employee Job Title

Incident Information

Absent from work Late to work Other

If absent/late to work, list date(s): t

From o

Received Doctor’s note:Yes No

Other incident:
Date of
Incident

Description of Incident:

Witness(es) to incident ________________________________________________________

Action Taken

What action was taken against the employee?

Spoke to employee Terminated employee Other

Did the employee offer any explanation for the conduct? If so, what was it?
Manager’s/Head’s Signature Date