Employee______________________________________________
Department_____________________________________________
_____ Written Warning _____ Final Warning
1. Statement of the problem:______________________________________
___________________________________________________________
___________________________________________________________
2. Prior discussion or warnings on this subject, wherther oral or
written:_____________________________________________________
___________________________________________________________
3. Company policy on this subject:________________________________
___________________________________________________________
___________________________________________________________
4. Summary of corrective action to be taken by the Company and/or
employee:___________________________________________________
___________________________________________________________
5. Consequences of failure to improve performance or correct
behavior:______________________________________________________
_____________________________________________________________
6. Employee Statement:____________________________________________
_____________________________________________________________
_____________________________________________________________
Employee Signature: ___________________________________Date_______
Management Approval: __________________________________Date______
Distribution: One copy to Employee, one copy to Supervisor and original to
Personnel File.