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DISCIPLINARY ACTION FORM
Fill out form completely. This form is to be completed on ALL disciplinary action taken. This form is applicable for ALL active personnel. Once complete, place a signed AND witnessed copy in the personnel file.
Discipline of others isn't punishment. You discipline to help, to improve, to correct, to prevent, not to punish, humiliate, or retaliate.
Pleasant View Volunteer Fire Department
"Proudly Serving With Professional Volunteers"
2425 Hwy 49E
PO Box 336
Pleasant View, TN 37146
615-746-8528
Officer/SC Information
Date of Report
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First Name
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Last Name
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Title
Phone Number
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Email Address
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OCO Name
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Was the OCO notified?
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Yes
No
Attempted
Personnel Information
First Name
*
Last Name
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Phone Number
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Title
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Email Address
*
Type of Discipline
Date of Incident
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Type
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Verbal Warning
Written Warning
Suspension
Termination
Demotion
Reason for Action
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Other Comments
*
Other Information
Officer Name:
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Officer Signature:
*
clear
Offenders Name
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Offenders Signature:
*
clear
Witness Name:
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Witness Signature:
*
clear
Upload any file or pics here
Have all parties sign electronic, print copy of form and place in file.