PERFORMANCE CORRECTION NOTICE

DISCIPLINARY LEVEL

Verbal Correction—(To memorialize the conversation.)

Written Warning—(State nature of offense, method of correction, and action to be taken if offense is repeated.)

Investigatory Leave—(Include length of time and nature of review.)

Final Written Warning

Without decision-making leave

With decision-making leave (Attach memo of instructions.)

With unpaid suspension

SUBJECT:Smoking on company grounds

Policy/Procedure Violation

Performance Transgression

Behavior/Conduct Infraction

Absenteeism/Tardiness

PRIOR NOTIFICATIONS

Incident Description and Supporting Details: Include the following information: Time, Place, Date of Occurrence, and Persons Present as well as Organizational Impact.

Karl,

Earlier today, a member of our security department reported that you were smoking a cigarette in the men’s restroom on the 27th floor. When I asked you if this was true, you confirmed for me that it was. Specifically, you told me that you were taking your ten-minute morning break and didn’t want to take the elevator to the ground level in order to smoke outside. You also told me that you are aware that smoking on company premises is a violation of standard operating procedures.

PERFORMANCE IMPROVEMENT PLAN

1. Measurable/Tangible Improvement Goals: Karl, I expect you to follow all company standards of performance and conduct, especially a rule that could jeopardize the health or safety of your coworkers. This rule is established not only by our company but by city ordinance. Consequently, I expect you to protect our company from outside legal challenges resulting from breaches of this policy.

2. Training or Special Direction to Be Provided: Attached is policy 1.21, Smoking (Tobacco and Tobacco Products). Please read the policy immediately and confirm with me tomorrow that you have read it, understand it, and agree to abide by it.

3. Interim Performance Evaluation Necessary? No

4. Our Employee Assistance Program (EAP) provider, Prime Behavioral Health Group, can be confidentially reached to assist you at (800) 555-5555. This is strictly voluntary. A booklet regarding the EAP’s services is available from Human Resources.

5. In addition, I recognize that you may have certain ideas to improve your performance. Therefore, I encourage you to provide your own Personal Improvement Plan Input and Suggestions:

(Attach additional sheets if needed.)

OUTCOMES AND CONSEQUENCES

Positive: I will remain available to help you and discuss areas where you require additional support. If you meet your performance goals, no further disciplinary action will be taken regarding this issue.

Negative: Company policy states the following: Smoking and the use of all tobacco products are prohibited inside and on all properties owned and/or operated by Johnson Oil and all of its corporate facilities . . . Employees in violation of this policy shall (1) receive a verbal warning notice for the first violation of this policy, (2) receive a written warning for a second violation, and (3) be subject to termination for a third offense. A copy of this document will be placed in your personnel file.

Scheduled Review Date: None

EMPLOYEE COMMENTS AND/OR REBUTTAL

EMPLOYEE ACKNOWLEDGMENT GOES HERE