Colorado Recreation Company
28368 Constellation Road #480 Valencia, CA 91355
(805) 285-3229 Fax: (805) 285-2046
EMPLOYEE DISCIPLINARY ACTION FORM
Employee:______________________________ Department:_______________________________
Date of Warning:_________________________ Supervisor:________________________________
TYPE OF VIOLATION:
o Attendance
o Safety
o Disobedience
o Work Quality
o Other
WARNING:
Violation Date:_____________________________
Violation Time:_____________________________
Violation
Place/Location:_____________________
_________________________________________
EMPLOYER STATEMENT:
EMPLOYEE STATEMENT:
WARNING DECISION:
Approved by:_____________________________________________________________
Name Title Date
List all interviews and the people who attended them.
Interview #1: Hearing and Viewing of Evidence
Attendee:_______________________________
Attendee:_______________________________
Attendee:_______________________________
Attendee:_______________________________
Date:___________________________________
Interview #2: Disposition
Attendee:_______________________________
Attendee:_______________________________
Attendee:_______________________________
Attendee:_______________________________
Date:_________________________________
I have read this ‘warning decision”. I understand it and have
received a copy of this document.
Employee Signature Date
Person who prepared statement Date
Supervisors Signature Date