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Download the Employee Write-Up Form which is a disciplinary report document used to warn or terminate an employee according to their actions. Generally this is a form that allows the employer to counsel with the employee as well, to provide documentation that the employer has provided ample opportunity for the employee to make appropriate changes in order to remain employed. An employer will usually allow 2 or more write-ups prior to consideration for termination. These documents are usually placed in an employee’s records for further evaluation at a later date.

How To Write

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 whomever 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 tell 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 –

  • Employee must be provided the opportunity to read the paragraph prior to providing signature – if 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

* Complete immediately and forward within 3 business days to : Director of Human Resources


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