Policy Manual sample

MDT Home Health Care Agency, Inc. EMPLOYEE WARNING/SUSPENSION/TERMINATION/REINSTATEMENT DATE HISTORY ____________ ____________ ____________ Employee Name: _________________________________ Department: _____________________________________ 9 WARNING As a result of this violation, the employee is being reprimanded for his/her action. Any further violations may warrant disciplinary actions, including employment termination. 9 SUSPENSION This violation constitutes suspension for the employee. The suspension may be up to 5 working days without pay, pending investigation. A notice of reinstatement or termination will be forthcoming. 9 REINSTATEMENT 9 TERMINATION Effective Date: ______________ EXPLANATION & REMARKS: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ________________________ __________ __________________ ________ Supervisor Signature Date Employee Signature Date 9 Check if employee refuses to sign Home Health Agency. - - Personnel/Operations Policies B-60