Employee Information

Incident Information

Action Taken

Type of Disciplinary Action
Previous Warnings

Manager Sign-Off

Acknowledgement
Clear Signature

Employee Acknowledgment

Please read this notice before you sign. Signing confirms you've received and discussed it with your manager. It doesn't mean you agree with it. You can add your side in the comments box below.

[Add your appeal or grievance process, for example: If you disagree with this action, write to [HR contact] within [X] working days.]

Clear Signature

When an employee needs a formal warning, the details matter: what happened, what action you’re taking, and whether the employee saw it. This employee disciplinary action form template lets a manager record the incident and the action, then hand the screen to the employee to read, comment, and sign before anything is filed.

It works for HR teams and managers in any business that issues verbal or written warnings, final warnings, suspensions, or terminations. Use it as an employee write-up form, a corrective action form, or a written warning notice, and add your own appeal process to the acknowledgment text.

How Does the Employee Disciplinary Action Form Template Work?

The template uses WPForms Pro and the Signatures addon, with signature fields for both the manager and the employee. It’s split into these sections:

  • Employee Information: The employee’s name, position, email, ID, department, and date of hire.
  • Incident Information: When and where it happened, any witnesses, and a description of what happened.
  • Action Taken: The type of action, from verbal warning to termination, the effective date, the reason, previous warnings, and a suspension end date that only appears for suspensions. There’s also room for the improvement you expect and what happens if the issue continues.
  • Manager Sign-Off and Employee Acknowledgment: The manager confirms the record and signs. The employee reads a short note explaining that signing confirms receipt, not agreement, adds any comments, and signs and dates the form.

When the form is submitted, HR gets an email with every answer and the employee gets a copy. You can add the PDF addon to save each record as a PDF, edit the action types, or change the acknowledgment wording to match your handbook. Disciplinary rules vary by location and contract, so have your process reviewed for your area.

Get WPForms Pro to start using this template, along with 2,000+ other pre-made form templates.