manager writes a disciplinary action form for an employee

How To Create And Use A Disciplinary Action Form

In an ideal world, all your employees would be perfect employees. They’d be skilled at their job, get along well with you and each other, and always behave in a professional manner. But this is not an ideal world. Now and again, an employee is going to do something that violates a policy established in your business handbook. Maybe it’s too many no-call, no-shows. Maybe it’s a conflict between two employees. Maybe it’s a conflict between a customer and an employee. Whatever the violation, when it happens, disciplinary action is required. That’s where the disciplinary action form becomes important.

In this article, the experts at Sling will tell you everything you need to know about this important piece of business paperwork. Along the way, we’ll answer such questions as:

  • What is a disciplinary action form?
  • Why do you need a disciplinary action form?
  • What information should be included on a disciplinary action form?

We’ll also give you step-by-step instructions for filling out a disciplinary action form so you’ll be ready when the need arises. We’ve even included a free disciplinary action form template at the end of this article that you can use as you see fit. Before we get to that, though, let’s start with the most basic question as it pertains to this subject: What is a disciplinary action form?

What Is A Disciplinary Action Form?

A disciplinary action form is designed to be used to inform an employee that he or she has violated a policy or expectation established by his employer. The form can be used as a simple warning or to indicate that some form of punishment will be administered. The main purpose of the disciplinary action form is to help the employee understand that his or her behavior (whatever it may be) is not appropriate and that a change needs to be made.

Why Do You Need A Disciplinary Action Form?

Coworkers using a disciplinary action form

Depending on the infraction, your first warning may have been a verbal reprimand of some sort. But if the infraction is serious enough, or if a less-serious infraction occurs again, it’s a good idea to fill out a disciplinary action form. Why is a form necessary? Because:

  1. The discipline will usually be unwelcome by the employee or employees involved.
  2. The information on the form may be used during legal proceedings.

In both of these cases, relying on your memory is unwise and can even cause more problems. After one verbal warning, or right away it the violation is serious enough, document everything in writing and present it to the employee. This helps him begin to see the importance of changing his behavior. It also covers you both within the business chain of command and legally should said employee decide to protest the discipline.

Now that we’ve defined the disciplinary action form and highlighted the importance of using one, let’s focus on the specific information that should be included.

What Information Should Be Included On A Disciplinary Action Form?

Manager creating a disciplinary action form

Every disciplinary action form should have these basic section in this general order:

  1. Employee information (e.g., name, date notice given, supervisor, etc.).
  2. Violation type (e.g., language, rudeness, disobedience, etc.).
  3. Violation details (e.g., date, time, and place violation occurred).
  4. Employer’s/supervisor’s statement of events.
  5. Employee’s statement of events.
  6. Judicial action recommended or taken (e.g., dock in pay, demotion, suspension, etc.).
  7. Previous warning information (e.g., date and whether verbal or written).
  8. Statement of receipt (signatures of both employer and employee).

Other sections can be added as necessary, but these eight sections should always be present. You use them to establish the who, what, where, and when of the violation along with a brief history of the employee’s behavior. Also included in these basic sections is the judicial decision dolled out and the verification that the employee received the information.

How To Fill Out A Disciplinary Action Form

Filling out a disciplinary action form

In this section, we’ll give you a step-by-step guide to filling out a disciplinary action form. One important thing to remember as you fill in the information is to always keep the language professional. Informal language can cause the employee to take offense and can even be used against you later on if legal proceedings ensue.

Please note, we are giving these instructions as they pertain to the disciplinary action form template included at the end of this article. Specific instructions for your form may differ. Also, it’s important to fill in all blanks with an indication that you haven’t forgotten this information. For example, if your business doesn’t have departments, you should write “N/A” (not applicable), or put a dash in the blank to show that you weren’t negligent in filling out the form.

Now, here are the instructions.

Employee Information

  1. On the line labeled “Employee,” fill in the employee’s full name.
  2. Enter the date the notice is written and delivered (preferably the same date).
  3. Include the department in which the employee works (if applicable).
  4. Write the name of the employee’s supervisor or manager.

Violation Type

  1. Circle the type of violation.
  2. If the violation is not listed, be sure to describe the infraction in the blank marked “Other”.

Violation Details

  1. Record the date and time the violation occurred.
  2. In the “Location of Violation” blank, document the specific location where the infraction took place (e.g., the kitchen, the break room, the bathroom, etc.), and the more general address of the business. This may seem redundant, but it can be useful in the event of legal proceedings.

Employer’s Statement of Events

  1. Describe in professional language what you (the employer or manager) witnessed when the violation occurred. It’s also important to include what you did immediately following the infraction.

Employee’s Statement of Events

  1. In this section, allow the employee to describe what happened from his perspective.

Judicial Action Recommended Or Taken

  1. Report whether or not disciplinary action should be taken. List the judicial action in this section.
  2. Include the signature and title of the person who approved the discipline.
  3. Date when the decision was approved.

Previous Warning Information

  1. Indicate the date previous warnings, if any, were issued.
  2. Circle the type of warning (e.g., verbal or written).

Statement Of Receipt

  1. Sign your name in the blank marked “Employer’s Signature”.
  2. Date the form, then print (don’t sign) your name.
  3. Include your title (e.g., manager, supervisor, owner) in the “Title” blank.
  4. Make a copy of the form you signed to give to the employee.
  5. After you have shown the form to the employee and explained the violation and what happens next, have the employee sign, date, and print his name and title (e.g., waiter, cook, food runner, barista, etc.) in the marked blanks.
  6. Keep the original for your files.
  7. Be sure to give the copy to the employee for his reference.

The final step in this process is to submit the disciplinary action form to the appropriate person or department within your business. If you send the form to another person, make a copy for your own records.

Disciplinary Action Form Template

Based on the information and instructions above, we have included a disciplinary action form template below to use in whatever manner you see fit. Use it exactly as is. Change a few words here and there. Change it completely until all that’s left is the formatting. Or use it as a starting point to produce your own disciplinary action form. Whatever you need to do to make your work life easier. That’s what Sling is here to do.

For more information about best practices for busy managers, and to see how the free Sling app can simplify the scheduling process, visit today.


Employee: __ Date Notice Given: __

Department: ___ Supervisor/Manager: __

Violation (circle one)

Attendance Language Disobedience Safety Arguing Tardiness

Work Quality Other: ___

Violation Details

Date of Violation: __ Time of Violation: ___

Location of Violation: __

Employer’s Statement of Events

Employee’s Statement of Events

Judicial Action Recommended or Taken

Decision Approved by: _ Title: _ Date: _

Previous Warning Information

1st Warning – Date: _ Type (circle one): Verbal Written

2nd Warning – Date: _ Type (circle one): Verbal Written

3rd Warning – Date: _ Type (circle one): Verbal Written

4th Warning – Date: _ Type (circle one): Verbal Written

Statement of Receipt


“I have explained all information regarding the employment violation and have provided the employee with a copy of the disciplinary action form.”

Employer’s Signature: __ Date: ___

Print Name: __ Title: ___


“I have read this disciplinary action notice and understand its contents. I also understand that this disciplinary action notice will be kept in my employee file indefinitely. I have received a copy of this disciplinary action notice.”

Employee’s Signature: _ Date: ___

Print Name: __ Title: ___

Original document on file at business name here.

See Here For Last Updated Dates: Link

This content is for informational purposes and is not intended as legal, tax, HR, or any other professional advice. Please contact an attorney or other professional for specific advice.

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