Sample only
Employee warning notice
Employee name
Type of violation
❑Attendance ❑ Carelessness ❑ Insubordination
❑Lateness/leaving early ❑Failure to follow instructions ❑ Violation of safety rules
❑Rudeness to employees/customers ❑Willful damage to material/equipment ❑ Working on personal matters
❑Unsatisfactory work quality ❑Violation of company policies ❑ Other:
or procedures
Previous warnings (Please note the date.)
Oral Written Delivered by whom?
1st warning
2nd warning
3rd warning
Employer statement Employee statement
Date of incident Time ❑ I agree with my employer’s statement
❑ I disagree with my employer’s description of the violation.
The reasons are
Action to be taken:
❑ Warning ❑ Probation ❑ Suspension ❑ Dismissal
❑ Other
Corrective action to be taken:
Consequences should incident occur again:
I have read this Employee Warning Notice and understand it.
Signature of employee Date:
Signature of supervisor who issued warning Date: