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Employee Disciplinary Action
Form HR-04 · BCC Group · Manager access only
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Personnel File · Form HR-04

Employee Disciplinary Action

Official record of a disciplinary action. Completed and submitted by the manager, then printed for review with the employee — both sign the printed copy, which is placed in the employee's personnel file.

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v2026.01

Employer information

Employee information

Incident

Disciplinary action

Progressive order: Step 1 Verbal → Step 2 Written (up to two) → Step 3 Final written. Suspension, demotion, or termination may follow after — or sooner for serious misconduct — and require HR-06 approval before delivery.

Employee response & acknowledgement

Employee acknowledgement. My signature below confirms that this disciplinary action was presented to and discussed with me, and that I received a copy. My signature indicates receipt only — it does not necessarily indicate agreement with the contents. I understand the corrective action required of me and that failure to improve may result in further disciplinary action, up to and including termination. Employment remains at-will. I understand I may submit a written response, which will be attached to this record in my personnel file.

Signatures are collected on the printed copy during the review with the employee.

Complete the form and submit, then print for employee review and signatures.