SUPERVISOR'S DISCIPLINARY CHECKLIST
Prepared by Kollman & Saucier, P.A.
Before imposing discipline, each supervisor must complete this checklist in full.
Employee's Name
________________________________________
Supervisor's Name
________________________________________
1. Identify the rule or policy violated.
____________________________________________________
____________________________________________________
____________________________________________________
2. Was the offense major __________ or minor __________?
3. If a minor offense, complete the following:
Has progressive discipline been followed?
Yes __________ No __________
Date of last violation ___________________________
Dates of prior violations:
_________________________
_________________________
_________________________
4. Was the employee aware of the rule, either through a posting, employee handbook, or similar communication?
____________________________________________________
5. How long has the individual been employed? _________________
If the employee is a long-term employee, is the proposed discipline too harsh? ________________________
6. Has the rule been similarly applied to other employees? ______
If not, why was the exception granted?
____________________________________________________
____________________________________________________
____________________________________________________
If not, what is the basis for imposing discipline under these circumstances?
____________________________________________________
____________________________________________________
____________________________________________________
7. Has the employee in question complained of allegedly illegal activities by the company, filed charges against the employer, engaged in union activities, or engaged in other protected activities?
____________________________________________________
8. List all witnesses, if any, to the rule violation.
____________________________
____________________________
____________________________
____________________________
9. Have statements been obtained from the witnesses, or have all witnesses been interviewed?
____________________________________________________
10. Set forth in detail the conduct upon which discipline is based.
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
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Fax: 410-727-4391 © 1999 - 2010 Kollman & Saucier, P.A. All rights reserved.
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