Employee write-up form

An employee write-up form with the type of issue, what happened, prior warnings, what has to change by when, the employee's comments and two signatures.

🇺🇸 US format · Letter size
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This is a sample form. Check that the terms and pay match federal and state labor rules and your company policy.

Fill in what you need. The preview updates as you type.

Company (optional)

Date of write-up

Employee name

Position and department

Supervisor

Date of incident

Type of issue

Description of the issue

Facts with dates and times. Name the handbook section when there is one.

Prior warnings (optional, date | type)

One per line. Empty leaves two blank lines.

What has to change

By when

Consequences if not corrected (optional)

Empty prints the sentence in the placeholder.

Signature lines

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State rules vary

State rules on final pay and notice vary. Check your state labor department. Some states require the final paycheck on the last day, others within a set number of days, and a few require written notice of the reason.

Employee Write-Up

Northwind Traders

Employee	Jordan Lee	Position	Warehouse Associate, Receiving
Supervisor	Taylor Kim, Receiving Supervisor	Date of write-up	October 8, 2026
Date of incident	October 6, 2026	Type of issue	■ Attendance □ Performance □ Conduct □ Safety □ Policy violation □ Other
Description of the issue	On Monday, October 6, Jordan clocked in at 8:52 am for an 8:00 am shift without calling the shift lead. This is the fourth late arrival of more than 30 minutes since September 1 (September 9, September 18, September 29 and October 6). The attendance policy in the handbook, section 4.2, asks employees to call the shift lead before the start of the shift when they will be late.
Prior warnings (date, type)	2026-09-19 \| Verbal warning about late arrivals, given by Taylor Kim 2026-09-30 \| Reminder of the call-in rule, by email
What has to change	Arrive and clock in by 8:00 am for every scheduled shift. If a delay cannot be avoided, call or text the shift lead before 8:00 am.
By when	November 7, 2026	Review date
Consequences if not corrected	Further corrective action, up to and including termination of employment.
Employee comments
I have read this write-up and received a copy. Signing does not mean I agree with it, and I may attach a written response. October 8, 2026 Employee signature: Jordan Lee Supervisor signature: Taylor Kim, Receiving Supervisor

State rules on final pay and notice vary. Check your state labor department.

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Employee Write-Up

Northwind Traders

Employee	Jordan Lee	Position	Warehouse Associate, Receiving
Supervisor	Taylor Kim, Receiving Supervisor	Date of write-up	October 8, 2026
Date of incident	October 6, 2026	Type of issue	■ Attendance □ Performance □ Conduct □ Safety □ Policy violation □ Other
Description of the issue	On Monday, October 6, Jordan clocked in at 8:52 am for an 8:00 am shift without calling the shift lead. This is the fourth late arrival of more than 30 minutes since September 1 (September 9, September 18, September 29 and October 6). The attendance policy in the handbook, section 4.2, asks employees to call the shift lead before the start of the shift when they will be late.
Prior warnings (date, type)	2026-09-19 \| Verbal warning about late arrivals, given by Taylor Kim 2026-09-30 \| Reminder of the call-in rule, by email
What has to change	Arrive and clock in by 8:00 am for every scheduled shift. If a delay cannot be avoided, call or text the shift lead before 8:00 am.
By when	November 7, 2026	Review date
Consequences if not corrected	Further corrective action, up to and including termination of employment.
Employee comments
I have read this write-up and received a copy. Signing does not mean I agree with it, and I may attach a written response. October 8, 2026 Employee signature: Jordan Lee Supervisor signature: Taylor Kim, Receiving Supervisor

State rules on final pay and notice vary. Check your state labor department.

How to use it

Fill in who, when and what kind of issue, then describe what happened in plain facts: dates, times, what was said or done, and the handbook section it falls under. List any earlier warnings with their dates, state what has to change and by when, and leave the consequences line as it is unless your policy says something more specific. The employee comments box stays blank for the meeting.

Go through the form with the employee in private, let them write comments, and both sign. The sentence above the signatures says that signing confirms receipt, not agreement. Give the employee a copy and file the original. If the issue continues, the next steps are the written warning letter and the performance improvement plan.

Things to watch

Write what you saw, not what you concluded about the person. Late four times with dates is a fact; unreliable is an opinion. Be consistent: if other employees were treated differently for the same issue, that becomes the story later. Keep the form out of shared folders.

Calculators that go with this

Frequently asked questions

What if the employee refuses to sign?

Write Employee declined to sign on the signature line, date it and have a witness initial it. The form still shows the employee was told. Offer to attach their written response instead.

Is a write-up the same as a written warning?

A write-up is the record of the incident and the conversation, usually on a form like this one. A written warning is a formal letter that states the warning level and the consequences. Many companies use the write-up first and the warning letter when the issue repeats.

How long does it stay in the file?

Company policy decides. Many handbooks say twelve months of clean conduct retires a write-up for progressive discipline purposes, but the document itself usually stays in the personnel file.

Is what I type saved anywhere?

No. Everything stays in your browser and nothing is sent to our server. If you refresh the page it is gone, so print, save a PDF or download the DOCX when you are done.