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Form: Verbal Warning

Warning issued by: Designation: Date of issue: Name of offender: Personnel number: Position: Validity of warning: To Department:

Date of offence:

Charge:

Details of offence:

I plead guilty to the transgression/offence. I understand that this is a verbal warning and that it will be kept on my personal file for record keeping purposes. I understand that this verbal warning is valid for a period of 3 months. I understand that the same or related offence in future may lead to disciplinary action, even dismissal. I understand that a witness may sign on my behalf should I refuse to sign this warning after its contents and implication was explained to me. The contents and implications of this warning were explained to me and I understand it completely. I was not forced nor influenced to sign this written warning.

Employee declares as follows:

Employer or designate signature: Witness signature:

Employee signature: Representative signature:

Should the Employee refuse to sign receipt of this Verbal Warning, the undersigned witnesses shall testify to the fact that the Employee received the warning and that its contents was explained to him/her. Alternatively that the warning was delivered at the employee's registered address. (Add comments)

Name Signature: Date

Name: Signature: Date:

Comments:

Strictly Private and Confidential

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