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[Company Name]

[Street Address]

[City, State ZIP]

[Phone] · [Email]

Written Warning

Disciplinary Notice

Date of Notice

[______, 20__]

Employee Information

Employee Name

[______________________________]

Position / Job Title

[______________________________]

Department

[______________________________]

Supervisor / Manager

[______________________________]

Date of Employment

[______, 20__]

Date of Incident

[______, 20__]

Nature of Violation — Check All That Apply

Attendance / Tardiness
Performance / Quality of Work
Conduct / Behavior
Safety Violation
Policy Violation
Insubordination
Harassment / Discrimination
Theft / Dishonesty
Other (describe below)

Description of Violation / Incident

[Describe the specific incident, behavior, or performance issue — include dates, times, witnesses, and relevant context.]

Prior Warning History

No prior warnings
Verbal warning — Date: [______]
1st written warning — Date: [______]
2nd written warning — Date: [______]

Required Corrective Action

[Specify the exact steps the employee must take, and by when, to correct the issue.]

Consequences of Continued Non-Compliance

Further written warning
Performance improvement plan (PIP)
Suspension without pay
Demotion
Termination of employment

[Additional notes if needed:]

Acknowledgment & Signatures

By signing below, the employee acknowledges receipt of this written warning. Acknowledgment of receipt does not constitute agreement with the contents of this notice.

Employee Signature

Date

Supervisor / Manager

Date

HR Representative

Date

This document should be retained in the employee's personnel file. Provide a copy to the employee at the time of signing.

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