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?
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)
When was employee hired?
Have the rules or performance standards been similarly
applied to other employees?
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"
List all witnesses to the rule violation or situation:
Have statements been obtained from the witnesses,
or have all witnesses been interviewed?
Set forth in detail the conduct upon which discipline
Are there any unusual facts or circumstances?
Coordinate with Human Resources.