Employee Write-Up Form PDF

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Employee Write-Up Template PDF Free Download

Employee Write-Up Form

When writing any of these forms (whether as an employer, manager, co-worker, or employee), it is very important to understand the consequences as this process can have repercussions that may affect your employment status.

Poor Example for Use

If you feel that your boss or manager is not treating you fairly because, for example, you always have to clean up and take the trash out, this may not be a valid grievance.

Good Example for Use

If your boss or manager is making inappropriate comments or sexually harassing you, this should be immediately addressed through one (1) of the available write-up forms.


Step 1 – Section 1 – Employee Information – Complete as follows:

Employee Name

Job Title

Department (in which the employee is assigned or in which the infraction/violation occurred)

Supervisor (name of supervisor implementing the write-up)

Date/Time of Occurrence (mm/dd/yyyy)

Location ( of the business in which the infraction/violation occurred)

Step 2 – Section 2 – Type of Offense –

Select the offense (s) for which the employee is being warned and check the appropriate lines pertaining to the offense (s)

Step 3 – Section 3 – Facts of Incident –

Write a narrative discussing the facts of the incident that had occurred to have warranted an employee write-up

Be certain to include the information that will be discussed with the employee and reasons why the write-up was necessary

If all of the information will not fit into the block on the form, attach a separate sheet with all information included for the purpose of explanation and legal documentation.

Step 4 – Section 4 – Past Disciplinary Action –

In this section identify past disciplinary actions in the blocks as follows:

Date mm/dd/yyyy

Type (of disciplinary action taken)

Details (explain the details of past actions taken)

If there were other actions taken in the past, in the block to the right of the lines provided, indicate whether or not there were written reports for past incidents by circling yes or no next to each line description.

Step 5 – Section 5 – Consequence If Incident Occurs Again –

Provide an explanation, that will be or has been discussed with the employee, with regard to the consequences if there is a repeat occurrence of said infraction/violation

If there is not enough space in the block provided, attach a separate sheet with the report, fully explaining the consequences

Step 6 – Section 6 – Completed By –

Completed By (name of supervisor, manager or whoever is entrusted to oversee the employee during their work shift)

Date mm/dd/yyyy

Step 7 – Section 7 – Employee Statement Regarding Facts Of Incident –

When an employee is accused of an incident, they have a legal right to place a written explanation into their employment record, agreeing to or opposing the accuser’s explanation or simply telling their side of the story.

The employee may place their explanation in the block provided – if more space is required – attach a separate sheet to place in the record along with this form.

Step 8 – Section 8 – Employee Acknowledgement –

The employee must be provided the opportunity to read the paragraph prior to providing a signature – if the employee agrees to the terms:

Employee Signature

Date mm/dd/yy

Witness Signature ( if any)

Date mm/dd/yyyy

Provide a copy of the completed document to the employee immediately

Language English
No. of Pages9
PDF Size2 MB

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Employee Write-Up Template PDF Free Download

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