Incident Report (first offense) The following report will be put into your personnel file and reflects that you did not follow the guidelines that were established by your supervisor. The situation described below is considered to be a formal oral notification of a violation of the established guidelines. If you have extenuating circumstances and feel that they should be reflected, please feel free to submit a written response. The next offense of a similar nature will result in a written warning.

Name of Staff Member______________________________ Date___________________

Described Incident______________________________________________________________

Supervisor's Signature___________________ Student's Signature____________________

Incident Report (second offense) The following report will be put into your personnel file and reflects that you did not follow the guidelines that were established by your supervisor. The situation described below is considered to be a formal written notification of a repeated violation of the established guidelines. If you have extenuating circumstances and feel that they should be reflected, please feel free to submit a written response. The next offense of a similar nature will result in a final warning.

Name of Staff Member______________________________ Date___________________

Described Incident______________________________________________________________

Supervisor's Signature___________________ Student's Signature____________________

Incident Report (third offense) The following report will be put into your personnel file and reflects that you did not follow the guidelines that were established by your supervisor. The situation described below is considered to be your final warning. One more violation of a similar nature and your employment will be terminated. If you have extenuating circumstances and feel that they should be reflected, please feel free to submit a written response.

Name of Staff Member______________________________ Date___________________

Described Incident______________________________________________________________

Supervisor's Signature___________________ Student's Signature____________________

Incident Report (termination) The following report will be put into your personnel file and reflects that you did not follow the guidelines that were established by your supervisor. The situation described below has caused us to terminate your employment. If you have extenuating circumstances and feel that they should be reflected, please feel free to submit a written response.

Name of Staff Member______________________________ Date___________________

Described Incident______________________________________________________________

Supervisor's Signature___________________ Student's Signature____________________