What is an employment disciplinary action form?

An employment disciplinary action form is an official letter issued to an employee whose actions don’t comply with company policy or expectations. It’s a formal document that informs the employee of any rules they have violated and the consequences that can occur if their behaviour doesn’t improve.

These forms usually allow employers to document issues related to an employee’s conduct and open a dialogue with them about their behaviour.

What to consider including in an employment disciplinary action form

Here is some information that can be helpful to include:

• full name of the employee, their job title, and their department
• date or dates on which the incident or incidents occurred
• description of the employee’s actions leading to the notice, including testimonials from witnesses, time of day, and any other pertinent information
• consequences of the employee’s actions
• suggestions for improvement and additional consequences if the behaviour continues
• name and signature of the employee’s direct supervisor
• details of the HR representative issuing the notice
• acknowledgement by the employee that they’ve received the notice and a statement of their intent to make improvements or correct the behaviour

Disciplinary form template

Employee warning notice
Name of employee: [first and last name]
Date of notice: [month/day/year]
Job title: [employee’s position]
Supervisor: [first and last name]

Violation
[A detailed description of their misconduct, including date and time]

Employer’s summary of events
[A summary of your concerns and corresponding evidence]

Employee statement
[Employees’ comments]

Action taken
[Consequences outlined in company policy]

Warning history
[warning number, date, and resulting action]

Acknowledgement of receipt and understanding

Employer

“I have explained the details of the violation and its severity to the employee. They have been given a copy of this form for their own records and understand that further corrective action will be taken if this behaviour continues.”

[Employer signature, title, and date]
[Witness signature, title, and date]

Employee

“I understand the contents of this document and the consequent disciplinary action. I have received a copy of this notice and understand a copy is going in my employee file.”

[Employee signature, printed name, and date]

Example of a completed employment disciplinary action form

Employee warning notice
Name of employee: Jacques Teal
Date of notice: 07/14/25
Job title: Sales Associate
Supervisor: Chase Harrison

Violation

Jacques arrived one hour late for his 8 am shift today with no prior warning or notice given to his supervisor.

Employer’s summary of events

This is Jacques’ second tardiness within the same month. His attitude upon arrival was dismissive and unprofessional.

An employee statement

My alarm didn’t go off this morning, and I overslept. In the future, I will take steps to make sure I arrive at work on time.

Action taken

This is our first formal warning. Further tardiness or misconduct in the next 90 days will result in an employee evaluation.

Warning history

Verbal warning given 7/2/2025

Acknowledgement of receipt and understanding

I have explained the details of the violation and its severity to the employee. They have been given a copy of this form for their own records and understand that further corrective action will be taken if this behaviour continues.

Chase Harrison, store manager, 7/14/2025
Amy Limperis, HR supervisor, 7/14/2025

I understand the contents of this document and the consequent disciplinary action. I have received a copy of this notice and understand that a copy is going into my employee file.
Jaques Teal, 7/14/2025

Using a well-structured disciplinary action form can help you fairly address misconduct, encourage employee improvement and maintain a professional workplace through clear documentation and open dialogue.

Employment disciplinary action form templates for PDF & Word

Use these employment disciplinary action form templates to document employee conduct issues and open up a dialogue to help them improve.