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EMPLOYEE <br /> WARNING REPORT <br /> Employees receiving this warning report are-hereby put on notice of a violation of our organization's rules and/or <br /> standards of employee conduct. Further violation(s) of such conduct may result in further discipline including the <br /> possible termination of employment. - <br /> Employee's Name Date <br /> Employee M Department Shift <br /> Copy Forwarded to: ❑Employee Representative ❑ Employee ❑ Other <br /> VIOLATION <br /> ❑ Attendance ❑ Carelessness ❑ Insubordination <br /> ❑ <br /> Lateness/Early Quit ❑ Violation of Company Policies ❑ <br /> or Procedures Violation of Safety Rules <br /> ❑ Unauthorized Absence From Work Area ❑ Willful Mate 'to Damage Working on Personal Matters/ <br /> g nal/Equipment ❑ Conflict of Interest <br /> ❑ Substandard Work Quality CJThreatening or Engaging in Violence ❑ Unsatisfactory Behavior Towards <br /> Employees or Customers <br /> ❑ Drinking(Drugs While at Work ❑ Unfit for Duty ❑ Other <br /> EMPLOYER'S STATEMENT EMPLOYEE'S STATEMENT <br /> Date of Violation / / Time: eni L) I agree with Employer's Statement <br /> ❑ I disagree with Employer's description of <br /> violation for these reasons: <br /> Empl,Y Signamro Date <br /> PREVIOUS WARNINGS <br /> DATE ORAL WRITTEN OTHER SUPERVISOR/MANAGER <br /> ACTION TIMETABLE FOR IMPROVEMENT <br /> ❑ Warning ❑ Suspension ❑ Dismissal Cl Other ❑ Immediate ❑ 30 days ❑ 60 days <br /> ❑ Other <br /> CONSEQUENCES <br /> Failure to Improve will result in: ❑ Warning ❑ Suspension ❑ Dismissal ❑ Other <br /> ❑I have read this Employee Warning Report and understand it. ❑Employee declined to sign this form. <br /> Date Employee Acknowledgement of Receipt Date Supervisor/Manager Signature <br /> MAIYISI RDA1Y1 <br /> From AMSTERDAM PRINTING AND LITHO,Am_terdam.N.Y.12010 1-800-833-6231 <br />