Discipline Report

Employee Name: *

Supervisor Name: *

Supervisor Email: *

Narrative of incident and conference/coaching: *

Is this a first instance? *

• Yes
• No

What was the previous conference/coaching? *

Do you want HR follow-up? *

• Yes
• No

What involvement is requested? *

• Performance Improvement Plan
• Conference
• Termination
• Other

Recommendations *

Submit