To prevent a recurrence, the following actions are required immediately:

___________________________ Date: ___________

I have read this notice and understand the nature of the disciplinary action. My signature does not necessarily indicate agreement with the findings, but acknowledges that the incident was discussed with me.

(Space for the employee to provide their perspective on the incident)

On [Date of Incident] at approximately [Time], an incident occurred at the Plymouth St. location. Specifically:

April 27, 2026 To: [Employee Name] From: [Supervisor/Manager Name] Subject: Formal Disciplinary Action – Incident on [Full Address, e.g., 123 Plymouth St.] 1. Type of Action Check one: Verbal Warning (documented) Written Warning Final Written Warning Suspension (Duration: [Number] days) 2. Description of the Incident

Failure to improve performance or further violations of company policy will result in further disciplinary action, up to and including termination of employment. 6. Employee Comments

State which company policy was breached (e.g., "Violation of Safety Protocol Section 4.2"). 3. Previous Discussions This is the first formal warning regarding this behavior.