Exit Employee Disciplinary Action Form Question Title * 1. Employee Name: Question Title * 2. Employee Phone Number: Question Title * 3. Employee Email: Question Title * 4. Manager Name: Question Title * 5. Manager Phone Number: Question Title * 6. Manager Email: Question Title * 7. Department: Question Title * 8. Date: Date Date Question Title * 9. Type of violation: Late/no-show Harassment or discrimination Safety violation Theft or damage of company property Conduct Other (please specify) Question Title * 10. Please describe the reason for the disciplinary action: Question Title * 11. Employee statement: Question Title * 12. What action was taken? (Select all that apply) Verbal warning Written warning Suspension Termination Question Title * 13. Plan for improvement: Question Title * 14. Additional comments: Done