Managers’ Discipline Checklist

Before imposing discipline, each supervisor should complete this checklist in full and then discuss the emerging situation with the Human Resource Director.

Employee’s Name:

Supervisor’s Name:

What rule or policy has been violated or performance standards not met (attach copies)?

Was there any prior notice?


Was the infraction/problem
q major or

Complete the following:

Has progressive discipline been issued?
q No

Date of violation:

Dates of prior violations:

If this discipline is for performance, has the employee been previously counseled and evaluated in writing under your procedures?

Date(s) of evaluation(s)

(Attach copies)

When was employee hired?

By whom?

Have the rules or performance standards been similarly applied to other employees?
q Yes
q No

Verify this:

If not, why was this an exception?

If not, were the employees of the same sex, race, age, nationality, religion, etc., of this employee?

If not, what is the basis for imposing different discipline under these circumstances?

Has the employee in question complained of allegedly illegal activities by the company, filed charges against the employer, engaged in union activities, or engaged in other "whistle-blower" activities?

List all witnesses to the rule violation or situation:

Have statements been obtained from the witnesses, or have all witnesses been interviewed?
q Yes
q No

Set forth in detail the conduct upon which discipline is based:

Are there any unusual facts or circumstances?

Coordinate with Human Resources.


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Last modified: November 14, 2002