Disciplinary Action Form – Document Builder 👷♂️ Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1234567Select your Country *— Select Choice —United StatesAustraliaAustriaCanadaFranceGermanyIndiaNigeriaNetherlandsNew ZealandSouth AfricaSouth KoreaSpainUnited KingdomState 🇺🇸 *— Select Choice —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCity 🇦🇺 *— Select Choice —Sydney (NSW)Melbourne (VIC)Brisbane (QLD)Perth (WA)Adelaide (SA)Canberra (ACT)Hobart (TAS)Darwin (NTState 🇦🇹 *— Select Choice —BurgenlandCarinthia (Kärnten)Lower Austria 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Case/Disciplinary Reference No *Case Opened On *Employee Full Name *Employee ID / NumberJob Title *Department/Team *Employee Email *Employee PhoneEmployment Type *— Select Choice —Full-timePart-timeTemporaryContractorInternOtherEmployment TypeWork Location / SiteManager/Supervisor Name *Manager/Supervisor Email *HR Representative HR Representative EmailUnion/Shop-Steward Representation?NoYesRepresentative NameRepresentative Email *Representative PhonePreviousNextSave and Resume Later 📅 Incident Details What happened, when, where, and who observed it. Incident Date *Incident TimeIncident Location/Site *Work Modality at Time *— Select Choice —On-siteRemoteHybridOff-site/ClientSafety Incident Involved? *NoYesCustomer/Client Impact? *NoYesNarrative Summary of Incident *Witnesses Present? *— Select Choice —None123+Witness #1 NameWitness #1 EmailWitness #2 NameWitness #2 EmailWitness #3+ NameWitness #3+ EmailLaw Enforcement Contacted? *NoYesCase/Report NumberNotes on Police InteractionPreviousNextSave and Resume Later 🔎 Investigation & Evidence Internal steps taken and the materials gathered. Investigation Start Date *Investigator(s) & Method • Required *Evidence Types Collected *Written statementsEmail/chat logsSystem access logsTime/attendance recordsCCTV/photosDevice forensicsPhysical itemsOtherEvidence Summary *Upload Evidence Files (ZIP/PDF) (optional) Drag & Drop Files, Choose Files to Upload Employee Given Opportunity to Respond During Investigation? *NoYesSummary of Employee Response *Interim Measures Applied? *NoneTemporary reassignmentPaid suspensionUnpaid suspensionAccess restrictionsOtherInterim Measures DetailsPreviousNextSave and Resume Later 📚 Policy Violations & ⏳ Prior History Map conduct to policies and note previous actions. Alleged Policy/Rule Violations *Code of ConductAttendance/TardinessSafety rulesHarassment/DiscriminationIT/Acceptable UseConfidentialityInsubordinationPerformance standardsSubstance policyOtherPolicy Citations / Sections *Prior Disciplinary History? *NoYesPrior IncidentsUpload Prior Notices (PDF) (optional) Drag & Drop Files, Choose Files to Upload Probationary Period? *NoYesProbation End Date (or weeks)PreviousNextSave and Resume Later ⚖️ Proposed Action & 🗣️ Employee Response Disciplinary level, corrective plan, and employee’s statement. Disciplinary Level *— Select Choice —Verbal counselingWritten warningFinal written warningSuspension (paid)Suspension (unpaid)DemotionTerminationPerformance Improvement Plan (PIP)Suspension DurationNew Position/GradeNew Pay (if applicable)PIP Goals & MetricsPIP Start DatePIP End Date Termination Effective DateWas employee offered a chance to respond now? *NoYes (written)Yes (meeting)Employee Written ResponseMeeting DateAttendeesMeeting Notes/OutcomePreviousNextSave and Resume Later ✅ Acknowledgements, ✍️ Signatures & 📎 Attachments Confirmations and formal sign-off. Employee Acknowledgements *I received a copy of this Disciplinary Notice.I understand that acknowledging receipt does not mean agreement.I was informed I may provide a written response.I was informed of my right to representation (where applicable).I will comply with corrective actions/expectations.Appeal Process Explained? *NoYesAppeal Instructions Employee Name for SignatureEmployee Sign DateName and Title of company signatory/sCompany sign date[File Upload] Attach Final Notice/PDF (optional) Drag & Drop Files, Choose Files to Upload Employee Response File(s) Allowed: PDF, DOCX (optional) Drag & Drop Files, Choose Files to Upload PreviousGenerate Draft DocumentSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. 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