• What happened and what was expected

  Facts with dates, times and places, how it came to light, who was involved, and the standard or policy it comes from.

• Anything said before, and the meeting

  Earlier conversations and outcomes, who attended, whether the employee was accompanied and what notice they had.

• What the employee said and the decision

  A fair summary including anything disputed, what was weighed including anything in the employee's favour, and the reasons.

• What is asked and what support is given

  Four rows of actions, training or supervision and a review meeting, and support the employer will provide.

• Record, next step and disagreeing

  How long the notice stays on record, what could happen if it continues, and how to disagree in writing, with receipt signed.

A disciplinary notice records a matter about an employee's work or conduct: what is said to have happened, what was expected and where it comes from, anything said before, the meeting and who attended, what the employee said, what has been decided and why, what the employee is asked to do, what support will be given, how long the notice stays on record, what could follow and how to disagree.

This blank form is completed by the employer and signed by the employer, the employee to confirm receipt and any person accompanying. Signing only confirms receipt. It does not decide whether a sanction is lawful or fair. Rules on procedure, representation, notice, pay and records differ by state, by contract and by employer size, so follow your own procedure and take advice before disciplining anyone, particularly where dismissal is possible.

Not sure? Talk to an attorney about your situation first.

These are separate documents, for different jobs.

• Employee termination lettersEnd someone's employment in writing.View document
• Harassment PolicySet out your workplace's rules against harassment.View document
• Employee EvaluationRecord an employee's performance review.View document
• Workplace dispute supportHelp resolving a dispute at work.View document

• A first written notice after repeated lateness
• A record of a meeting about a conduct issue
• A notice that sets training and a review date

• Employment agreementsSet out pay, role and terms for an employee.View document
• Offer lettersMake a job offer in writing, with its key terms.View document
• Employee handbooksThe policies and expectations for your staff, in one place.View document
• Workplace policiesSet out how your workplace runs on a specific issue.View document