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Employee Disciplinary/Termination Form
Employee Advisory Form
First Name :
*
Last Name :
*
Employee ID :
*
Date :
*
Jobsite :
Supervisor :
Documented Disciplinary Action and/or Employee Statement
Verbal Warning
Written Warning
Employee Statement or Refuse to Sign
Safety Warning
Explanation of lssue (Required)
Safety – Fall Protection Issue
Attendance Issue – Tardiness / Leave Early
Safety – Scaffold Issue
No Call, No Show
Improper use of Equipment / PPE
Did not Follow Policy / Rules
Disruptive
If Needed, Explain Other or Add Employee Statement – Please list below
Disciplinary Action Taken (Required)
Sent Home - One Day
Sent Home - Two Days
Sent Home - One Week
Terminated
Change Locations
No Action Needed
Re-Training Requested
If Needed, Explain Other – Please list below
Documented Termination
Disciplinary Date :
*
Last Day Worked :
Voluntary :
Quit / Resigned With Notice (Letter / Email / Text)
Quit / Resigned Without Notice / Job Abandonment
Other(see explanation below)
Involuntary :
Poor Performance
Other(see explanation below)
Laid Off
Violation of Policy
Termination Explanation (Required)
Signatures are indicators that the above information is accurate.
Employee Signature :
Clear Signature
Supervisor Signature :
Clear Signature
Foreman Email:
*
Other Email:
Upload Files :
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