Record of Disciplinary Action and Proposed Changes

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Date

{{date}}

Employee Information

Employee Name: {{employee_name}}

Employee ID: {{employee_id}}

Department: {{department}}

Job Title: {{job_title}}

Formal Notification of Disciplinary Action

This letter formally notifies you of disciplinary action taken against you by {{company_name}}.

This action is the result of a thorough review of your conduct/performance concerning the following matter(s):

Details of Incident(s) or Performance Issue(s)

Date(s) of Incident(s): {{dates_of_incidents}}

Description of Incident(s) / Performance Issue(s):

Relevant Company Policy or Standard Violated

The incident(s) or performance issue(s) described above are in violation of the following company policy/standard:

Policy/Standard Name: {{policy_name}}

Relevant Section(s): {{policy_section}}

Previous Discussions and Warnings (if applicable)

Please note that this is not the first instance where concerns regarding your {{conduct_or_performance}} have been raised. Previous discussions/warnings include:

Date(s): {{dates_of_previous_warnings}}

Summary of Previous Warnings: {{summary_of_previous_warnings}}

Disciplinary Action Taken

Based on the severity of the incident(s) and/or your disciplinary record, the following disciplinary action is being taken:

(Please tick applicable)

[ ] Verbal Warning

[ ] Written Warning

[ ] Final Written Warning

[ ] Suspension Without Pay ({{suspension_days}} days, from {{suspension_start_date}} to {{suspension_end_date}})

[ ] Demotion (to {{new_job_title}}, effective {{demotion_effective_date}})

[ ] Termination of Employment (effective {{termination_effective_date}})

Reason for Termination: {{reason_for_termination}}

Required Changes and Improvement Plan

To rectify the identified issues and prevent recurrence, it is imperative that you undertake the following changes and improvements:

1. {{required_change_1}}

2. {{required_change_2}}

3. {{required_change_3}}

An improvement plan, focusing on {{area_of_improvement}}, will be developed and implemented with your manager, {{manager_name}}, by {{improvement_plan_date}}.

Consequences of Non-Compliance

Failure to adhere to the required changes and improvement plan outlined above may result in further disciplinary action, up to and including termination of employment.

Employee Acknowledgment and Right to Appeal

I, {{employee_name}}, acknowledge receipt of this Record of Disciplinary Action and understand its contents. I understand that I have the right to appeal this decision within {{number_of_days}} working days from the date of this letter by submitting a written appeal to {{appeal_recipient}}.

Employee Signature: _______________________

Date: _______________________

Management Acknowledgment

Manager's Name: {{manager_name}}

Manager's Signature: _______________________

Date: _______________________

HR Representative Name: {{hr_name}}

HR Representative Signature: _______________________

Date: _______________________