University of Houston-Victoria
Written Reprimand (Example)
FORM B

To:  Employee Name 
Employee ID
From: Supervisor Name                
Supervisor Title
Date
Subject: Written Reprimand

 

In the first paragraph, summarize the reason for the written reprimand.

This is an official written reprimand for your continued failure to report to work at the time and place scheduled for your job.

In the second paragraph, cite previous counseling including date(s) if possible, and list number of infractions and dates of occurrences since the counseling took place.

You were previously counseled about the importance of reporting to work at the proper time and place on (date). Since that date, you have reported to your scheduled worksite late on three occasions: (list dates).

In the next paragraph, state the problems that result from the employee's failure to perform according to standards.

I am reminding you, with this written reprimand, of the importance of reporting to the proper worksite on time each day. Your failure to report at the time and place scheduled for you creates an additional burden for other members of your work group. It impairs the efficiency, productivity, and morale of your work group.

In the final paragraph, state the consequence of failure to correct the behavior. If the behavior might result in dismissal, the employee must be warned of that possibility.

Further violations of the agreement we reached in the September oral counseling session may result in additional disciplinary action, including the possibility of suspension without pay and/or dismissal from employment.

Above the employee signature block, provide an "Employee Acknowledgement" stating that the employee's signature documents receipt of the written reprimand but not necessarily agreement with its content.

EMPLOYEE ACKNOWLEDGEMENT: I acknowledge receipt of this written reprimand but not necessarily agreement with its content. I understand that a copy of this written reprimand will be placed in my official personnel file and that I have the right to prepare a letter of rebuttal to be attached to the written reprimand.

 

_______________________________________ 					___________________________ 
Employee's Signature		 										 Date