Disciplinary Action Form – Fill Out and Use This PDF

Updated: Nov 9, 2026

A Disciplinary Action form is a document used by employers to record incidents involving employee violations, such as attendance issues, carelessness, safety violations, tardiness, and other types of misconduct. The form captures details like the date and time of the violation, statements from both the employer and the employee, the decision regarding the warning, and a record of any previous warnings. Interested in managing workplace conduct more effectively? Click the button below to start filling out your Disciplinary Action form today.

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Write-Up Form PDF Details

When an employee's behavior or performance falls below the company's standards, the disciplinary action form becomes a crucial document. It serves multiple purposes: to record the details of the infraction, provide a clear description of the violation whether it be attendance, carelessness, safety, tardiness, or another issue, and outline the warning given, whether it's a first warning or a subsequent one. This form also includes sections for both an employer and an employee statement, ensuring that both sides have the opportunity to document their perspective. The decision, authorized by a supervisor or other approved figure, is then recorded, including the date and specifics of any previous warnings for context. By requiring signatures from the involved employee, the preparer of the warning, and potentially a supervisor, the form ensures acknowledgment from all parties. Furthermore, the distribution of copies to relevant departments, such as Human Resources, ensures that the disciplinary action is officially noted and stored for future reference. This process not only aids in maintaining clear, direct communication but also safeguards both the employer and the employee by providing a transparent record of actions taken.

Question	Answer
Form Name	Disciplinary Action Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	employee write up forms, employee write up form, employee disciplinary write up form, disciplinary action form

How to Fill Out Employee Disciplinary Action Form

Employee Disciplinary Action Form at a glance

What it is: The Employee Disciplinary Action Form has an Employer Statement, an Employee Statement and a Warning Decision.

Who signs: Signatures go on the Employee Signature, Signature of person who prepared warning and Supervisor's Signature lines.

A filled-in Employee Disciplinary Action Form example: a supervisor records a warning after a 1st Warning

Employee Disciplinary Action Form example filled out, example: a supervisor records a warning after a 1st Warning — A supervisor completes the Employee Disciplinary Action Form for an employee. Tardiness is marked for 3 late arrivals, so the other TYPE OF VIOLATION boxes stay empty. The picture shows page 1; its names and figures are sample values. The 1st Warning is the only previous warning, so the 2nd Warning and 3rd Warning lines stay empty. All three COPY DISTRIBUTION boxes are marked because the employee, HR Dept and supervisor each receive a copy.

How to fill out Employee Disciplinary Action Form, box by box

Employee, department, date of warning and supervisor

Fill in Employee, Date of Warning, Department and Supervisor.

Type of violation

Under TYPE OF VIOLATION, mark Attendance, Carelessness, Disobedience, Safety, Tardiness, Work Quality Violation or Other.

Violation date, time and place

Enter the Violation Date, the Violation Time (a.m. / p.m.) and the Place Violation Occurred.

Employer statement

Write the EMPLOYER STATEMENT.

Employee statement

Write the EMPLOYEE STATEMENT.

Warning decision and approval

Under WARNING DECISION, fill in Approved by: with the Name, Title and Date.

Previous warnings

Under List All Previous Warnings (when warned and by whom), enter the Date and fill in the Verbal or Written line for the 1st Warning, 2nd Warning and 3rd Warning.

Signing the warning decision

At "I have read this "warning decision". I understand it and have received a copy of the same.", sign on the Employee Signature line and enter the Date.

Sign on the Signature of person who prepared warning line and enter the Date.

Sign on the Supervisor's Signature line and enter the Date.

Copy distribution

Under COPY DISTRIBUTION, mark Employee, HR Dept or Supervisor.

Sources

[1] Employee Disciplinary Action Form (served file) (the Official source link on this page).