Employee Disciplinary Action Form Lubbock Select a Choice*AttendanceOtherCarelessnessDisobedianceSafetyTardinessWork QualityViolation Date and Time (mm/dd/yyyy HH:mm) 010203040506070809101112:000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 ampmPlace Violation OccuredType of ViolationSupervisor*Location*MW01MW05MW07MW09MW10MW11Date of Action* (mm/dd/yyyy)Employee*Employer Statement*Employee Statement*Warning Decision*Supervisor's Signature*Signature of person who prepared warning*Employee Signature*Date (mm/dd/yyyy)Date (mm/dd/yyyy)Date (mm/dd/yyyy) Payment options Submit
