Fill and Sign the Managers Checklist for Final Discipline Form

MANAGER’S CHECKLIST FOR FINAL DISCIPLINE Complete prior to decision.Employee’s Name: Date: Time With Company: Department: PROBLEM:Employee(s) involved. Details of what happened. How did it happen? Specific facts to be considered (no opinions). Did you give the employee a chance to tell his/her side of the story? Yes No Explain. Was your interview with the employee in private? Yes No Was the employee aware of the rule, procedure, or policy being breached? Yes No Was the rule published in writing and disseminated to all employees? Yes No Do you have written confirmation of receipt of that communication? Yes No Explain how the rule has been enforced in the past. What changes in behavior need to be made? Have past changes affected current situations? Yes No Explain.What is the employee’s past record? Can you back up this record with facts? Yes NoDid the employee have any previous warning? Yes NoHas this violation been previously overlooked? Yes NoAccording to policy, what is appropriate and justifiable discipline? Verbal warning Written warning Placed on probation Discharge In your opinion, will corrective action prevent a recurrence and encourage better performance? Yes No Did you check with any/all of the following before taking disciplinary action? Your Manager Human Resources Other Executives FUTURE ACTIONIs any follow-up action necessary? How do you plan to monitor? Have you recorded this incident and put a copy in the employee’s personnel file? Yes NoHave you allowed the employee to impart a rebuttal? Yes No