Employee Name* First Last Most Recent Work Site/ Post Location* Date of Termination* MM slash DD slash YYYY Last Date Worked* MM slash DD slash YYYY Reason for Termination*Was there a final incident that led to the termination?* Yes No Explantion of Final Incident*Were any prior warnings given?* Yes No Explanation of Prior Warnings*Name of Terminating Supervisor* First Last Phone Number of Terminating Supervisor* Δ