Exclusively Represented Employees
Revised October, 2013 /

NOTICE OF INVESTIGATORY LEAVE or CORRECTIVE ACTION

Employee Name / Title / University ID
Department Name / Department / Division
Supervisor / Department HRA

Investigatory Leave (L 743 Only)

Must consult with Employee & Labor Relations

☐ Yes, / working days from / to / ☐ Paid / ☐ Unpaid

LEVEL OF CORRECTIVE ACTION TAKEN

The level of corrective action (e.g., Oral Warning ð Termination) depends on a variety of factors.

Supervisors should consult with the Departmental HRA prior to initiating corrective action.

☐ Oral Reprimand / Warning / ☐ Final Written Warning and/or Suspension
☐ Written Reprimand / Warning / ☐ Termination

REASON(S) FOR CORRECTIVE ACTION

☐ Attendance: Includes unscheduled absences (full or partial day not scheduled and approved in advance), unauthorized absences from assigned / scheduled area / ☐ Misuse of University Electronic Information Systems Includes misuse of lists, e-mail, divisional and/or University electronic information
☐ Behavior and or Language of a Threatening or Abusive Nature / ☐ Performance: Unsatisfactory Performance of Duties
☐ Call-In Policy Violation: Not adhering to Departmental Call-In Policy / ☐ Property: Misuse / Damage / Loss of University Property
☐ Customer Service: Unsatisfactory service to public, students, patients, staff, vendors, or contractors / ☐ Records & Information: Disclosure, Falsification, Alteration or Improper Handling of Records or Information
☐ Failure to Comply with University Policies and/or Procedures / ☐ Sleeping on the Job
☐ Fighting / ☐ Theft
☐ Insubordination / ☐ Possession of Weapon on University property
☐ Intoxicants or Drugs: Sale/purchase of intoxicants or drugs, or possession of non-prescribed drugs, or working under the influence of drugs or alcohol / ☐ Other (specify) ______

ATTACHMENT: Document explaining Corrective Action

Employee’s signature acknowledges the corrective action was discussed with her/him, it does NOT indicate that the employee agrees with the action.

Supervisor / Date / HRA
Employee / Date / HR

Scan and email this form to Retain the original for the Department.

A copy of this form was ☐ given to ☐ mailed to the above-named employee and to the Union Representative on ______.