Personnel Action Notice (PAN)

 Hello  , you have been issued a Personnel Action Notice which requires your review and signature. Please review the following information and sign the document as requested. Failure to sign receipt of documentation is a violation of company policy. You are required to sign for receipt of this information only. Failure to sign for receipt will be considered insubordination and could be grounds for immediate termination. 


Which actions are occuring:

Which facility: 


Original hire date: 




Warning type: 

Previous discipline documents on file: 

Violation type: 

Please define other: 

Employer notes: 

Action to be taken: 

Please define other: 

Consequences should incident occur again: 

Please define other: 

Personnel Record Entry

Accident or incident type: 

Safety Record: 

Employee Notification

Purpose of Notification: 

Requestors Name: 

Employer Notes: 

By signing this document, I neither agree or disagree with the information contained within, however, by signing this document I acknowledge that I have received the information. Additionally, I am aware that once I have looked at this document, it has been recorded within the system as having been read. I understand that refusal to sign for receipt of this information will be considered as disregard for company policy and insubordination. This may be grounds for immeduate termination. 

I have received and reviewed the provided information.


I also understand that I will be granted the right and opportunity to discuss this information with my supervisor or manager and will be allowed to submit additional information related to this matter. Should additional information provided alter the findings related to this matter, I will be allowed to request a correction as appropriate to this entry.

I have received and reviewed the provided information.


Leave this empty:

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Signature Certificate
Document name: Personnel Action Notice (PAN)
lock iconUnique Document ID: 2fc1e0b2fa70997b824dc0e532cfd545c28a253b
Timestamp Audit
01/18/2018 09:50 PSTPersonnel Action Notice (PAN) Uploaded by Beeline Tours Hiring Manager - IP