LABOUR MANAGEMENT

SERVICES
Disciplinary Code and Procedure
1. Objectives

This procedure applies in all cases where employees are alleged to have breached a rule regulating conduct
or in respect of unacceptable performance in the workplace (whether that rule is in writing or not).

The objectives of this procedure are to ensure that:

1.1 Allegations of misconduct are dealt with in a consistent substantively fair manner;

1.2 There is a fair procedure to determine what disciplinary action is appropriate, if any.

2. Forms of Discipline

2.1 There is a distinction between disciplinary action and counselling. In general, counselling is appropriate
where employees are not performing to standard, or are unaware of a rule regulating conduct and/or where
the breach of the rules is relatively minor and can be condoned. Disciplinary action will be appropriate where
a breach of the rules cannot be condoned, or where counselling has failed to achieve the desired effect.

2.2 Disciplinary action may take the following forms, depending on the seriousness of the matter:

• Verbal warning
• Written warning
• Final written warning
• Temporary suspension of employment with / without pay
• Dismissal with / without notice

3. The Application of Discipline

3.1 It is the sole responsibility of the management to decide when it is necessary to apply this procedure,
and what form of disciplinary action is appropriate.

3.2 Before deciding what form of disciplinary action is appropriate, management may decide to meet the
employee concerned, in order to explain the nature of the rule s/he is alleged to have breached, and give the
employee an opportunity to explain her or his conduct. Such meeting does not constitute a formal inquiry.

3.2 The different forms of disciplinary action, and the procedure relating to formal inquiry’s and reviews, are
described more fully below:

4. Verbal Warning

4.1 Verbal warnings are appropriate in the case of minor offences, or where an employee breaches a rule for
the first time, but it is not necessary to issue a written warning.

4.2 The appropriate Manager may issue a verbal warning, which will be recorded on the employees file as a
verbal warning, which is valid for a period of 3 months.

5. Written Warning

5.1 Written warnings are appropriate where an employee shows disregard for verbal warning(s) given, or in

Labour Management Services - Code Procedure Revision 09/2007 © 1

the case of a more serious offence/s.

5.2 The Manager may independently issue a written warning, after meeting the employee concerned. This
warning will be forwarded to Personnel to be placed on the employee’s personal file.

5.3 A written warning must briefly describe the nature of the breach-giving rise to the warning.

5.4 Written warnings shall remain valid for 6 months

6. Final Written Warnings

6.1 Final written warnings are appropriate where an employee has received a written warning for the same
or a similar breach of rules.

6.2 The [Industrial Relations Manager / Authorised designate] may issue a final written warning, after
meeting the employee concerned, or after a disciplinary inquiry.

6.3 A final written warning must briefly describe the nature of the breach-giving rise to the warning.

6.4 If an employee disputes a final written warning given after a meeting, s/he may request a formal inquiry,
to review such warning within 3 days of receiving such warning.

6.5 A final written warning shall remain valid for [9 months].

6.6 The [Industrial Relations Manager] must inform the employee that a failure to heed a final written warning
may result in dismissal.

7. Temporary suspension of employment with / without pay

7.1 The Company is entitled to suspend an employee on full pay pending an investigation into any
alleged breach of the disciplinary code, or where the Company at its sole discretion believes that the
employee’s attendance at work may be disruptive.

7.2 Should the employee wish to appeal against suspension , a written representation must reach the
Company within 24 hours of notification of suspension.

7.3 An employee may, as a last alternative to dismissal, be suspended without pay on condition that
the employee unconditionally and without prejudice to the Company agrees to the suspension in
writing. Should an employee agree to a period of unpaid suspension the employee will forfeit any right
to dispute the fairness of the suspension.

7.4 During the period of suspension, the employee will not be permitted on the Company's premises
unless written permission has been given to the employee or for the purposes of attending an
investigation.

8. Dismissal with / without notice

8.1 Dismissal may be with notice, in terms of the notice periods prescribed in the employee’s conditions of
employment, or summary dismissal.

8.2 An employee who is dismissed must be informed that’s/he has the right to appeal, or to refer a dispute in
terms of the Labour Relations Act of 1995 within 30 days of the date on which the employee was dismissed.

8.3 Dismissals are appropriate where a written / final written warning is considered inadequate because of
the seriousness of the breach of the rules.

8.4 The [Industrial Relations Manager/ Authorised designate] may dismiss an employee after a disciplinary
inquiry.

9. Appeals

Labour Management Services - Code Procedure Revision 09/2007 © 2

9.1 An employee who is dismissed shall be entitled to appeal against such dismissal.

9.2 Appeals must be noted in writing within three (3) days of the decision to the chairperson of the inquiry,
stating the grounds of appeal.

9.3 The [appropriate managerial structure] shall determine if it is necessary to hear further evidence, or to
allow further submissions to be made, and may confirm, vary or uphold any appeal.

9.4 The [appropriate managerial structure] may delegate its powers in 9.3 to a sub-committee or
representative.

9.5 In the event that dismissal is confirmed, the date of dismissal shall be that date on which the original
decision to dismiss was given.

10. Disciplinary Inquiry

A disciplinary inquiry must be held when:

10. 1 Action stronger than a final written warning may be warranted, in the opinion of the [appropriate
manager] or when an employee has received a final written warning and requests a formal inquiry.

10.2 An employee may be suspended on full pay pending such a inquiry, where the presence of the
employee at the workplace may jeopardize any investigation into the alleged misconduct, or poses any
threat to the safety or well - being of any employee, including management.

10.3 The [appropriate Manager] shall give the employee not less than 24 HOURS notice of the time and date
of a inquiry, and the charge against her or him.

10.4 The following persons should/ may be present at such a inquiry:

• A Chairperson, being a Director/ I.R. Manager or her/his nominee
• A Management representative/ Complainant, who will present the evidence against the employee charged
• The employee charged
• The employee’s representative (only a fellow employee or a shop steward)
• Any witnesses Management / Complainant or the employee charged wishes to call
• An interpreter, if the employee requires and requests one

10.5 At a inquiry, the employee charged and for his/her representative shall have a full opportunity to present
his/her case, to cross-examine any witnesses called in support of the charge, and to have reasonable
access to documents and objects relevant to the charge.

10.6 At the conclusion of the inquiry the Chairperson shall make a finding of guilty or not guilty on the
charge.

10.7 The failure of the person charged and or his representative to attend the inquiry shall not invalidate the
proceedings, except if good cause can be shown in writing to the chairperson within 3 days of the inquiry, for
not attending.

10.8 In the event of a staff member being found guilty, the Chairperson must ask both the employee or
her/his representative and the management to make submissions on the appropriate disciplinary sanction as
well as submissions on mitigation and seriousness of the employee’s actions.

10.9 The Chairperson must then decide what disciplinary action to take, and inform the employee
accordingly.

11.Offences

Labour Management Services - Code Procedure Revision 09/2007 © 3

Offences can be divided into two broad categories, namely:

11.1 Serious Offences

These could, subject to an inquiry, result in action against employees in the form of instant dismissal.

Examples of Serious Offences:

• Theft, bribery or fraud

• Falsification of the Company’s records
• Misuse of the Company’s property for private purposes (constitutes theft)
• Gross negligence or incompetence
• Sexual harassment
• Rendering of false statements when applying for employment / during employment or in the submission
by way of CV, application form etc.
• Unauthorised absenteeism
• Wilful damage to the Company’s equipment or the property of other employees, or the property of clients
• Fighting, assault or attempted / threatened assault
• Inebriation or intoxication due to the abuse of substances, known to have such an effect, such as
alcohol, drugs and in some instances, prescription medicines. Effectively being "drunk" or under the
influence of narcotic substances during work hours (As indicated by company observation check list)
• Causing damage to the Company’s / colleges and / or clients property
• Sabotage by damaging machinery or equipment or causing damage to the company’s property in any
way whatsoever
• Refusal to obey lawful instructions given to the employee by a supervisor designated by the Company
• Failure to report misconduct,
• Unsanitary acts such as expectorating (spitting), urinating or defecating outside of designated toilet
areas whilst on the Company’s premises
• Desertion / absconding, absent a period of 5 working days without acceptable reason or without
informing direct manager of reasons for absence
• Persistent moderate offence misconduct
• Being disrespectful, rude or uncooperative towards debtors or clients resulting in the disruption of, or
loss of, business.
• Sleeping while on duty

11.2 Moderate Offences

These usually consist of breaches of general discipline resulting in disciplinary action. The manager or
supervisor does not have to call a disciplinary inquiry for these offences

Examples of Moderate Offences:

• Laziness, loafing: passing time idly or failing without reasonable cause to complete tasks set
• Poor workmanship / inefficiency: failure to carry out work to the required standard without reasonable
cause and concealing defective work
• Poor time keeping, e.g. late coming, extended breaks or leaving early
• Disorderly behaviour on Company’s premises
• Negligence: Negligent loss, damage or misuse of Company’s property / failure to exercise proper care in
executing duties to the extent that tasks have to be repeated
• Absence from the workplace while on duty without permission
• Being disrespectful, rude or uncooperative towards clients, fellow employees and management.
• Not complying with company dress code

NB: The examples listed are not exhaustive and serve only for illustration the Company is not bound by
these examples which will only serve as a guide.

11.3 Formal disciplinary inquiry

The following principles must be observed at that inquiry:

Labour Management Services - Code Procedure Revision 09/2007 © 4

 • The inquiry must be held as soon as possible after the event, provided that a reasonable time is
afforded to the employee to prepare his/her defence (normally 24 hours);
• The employee may, if necessary, be suspended on pay, prior to, during or pending the outcome of
the inquiry;
• The employee will within a reasonable time, normally five days, after the commitment of the alleged
offence be notified in writing of;

The date, time and venue of the inquiry; and the misconduct which he/she is alleged to have
committed and of his/her rights at the inquiry, will be stipulated in clear unequivocal language

Conducting the Formal Disciplinary Inquiry

Normally present at the inquiry are:

The Chairperson of the inquiry. The Chairperson must not be the complainant, nor
the person against whom the offence was
committed or a person who has prior knowledge of
the complaint or circumstances surrounding the
issue.

The accused.

The representative for the accused.

(A fellow employee representative) Unless the accused does not require representation
(the representative must be a fellow employee. No
outside representation will be allowed). It is the
accused’s responsibility to secure the attendance of
their representative.

Interpreter (if necessary). If required the accused must advise 2

hours prior to the start of proceeding’s

The Complainant
Witnesses It Is the Accused’s / Complainant’s responsibility to
secure the attendance of their witnesses.

12 . THE INQUIRY: PROCESS

At the commencement of the inquiry the Chairperson will read out and explain the process to be followed.
•. Ensure employee received notification and had time to prepare.
•. Charge to be put to accused
•. Accused to plea
•. The evidence of the complainant and his/her witnesses will be heard first. Witness only present
when giving evidence.
•. The employee/ representative and chairperson may ask questions of the evidence.
•. The employee and his/her witnesses may then give evidence and they may be asked questions
by the complainant and chairperson.
•. The chairperson will make a decision on guilt
•. Then only inspect the employee’s file,
•. Closing argument, hear mitigation
•. Then decide what action to take and inform employee
•. Advise employee of right to appeal / declare dispute

The employee’s rights at the inquiry are to:

• Have an interpreter, if requested.

• Have representation by a fellow employee, if requested.
• Have the opportunity to confer with the representative, at reasonable times before, during and after the
inquiry.

Labour Management Services - Code Procedure Revision 09/2007 © 5

• Question the complainant and witness during the inquiry either himself or through his representative.
• Give evidence himself/herself to call witnesses to give evidence and to argue either himself/herself or
through his/her representative on the question of whether the misconduct occurred.
• Give evidence himself/herself, to call witnesses to give evidence and to argue either himself/herself or
through his/her representative in mitigation of disciplinary action.
• After inquiry all sides of the case, the Chairperson must decide whether the alleged misconduct was
committed or not and if so, on the action to be taken.
• The action taken should be in line with the Company’s policy and thus with previous decisions involving
the same or substantially the same circumstances.

The Chairperson must not consult the employee’s previous work records until after he has reached a
decision on whether or not the alleged misconduct was committed.

13 . Industrial Action

In the event of collective industrial action by employees it shall not be necessary for the Company to conduct
individual disciplinary breaches arising out of such collective industrial action. If the Company has notified its
intention to discipline participating employees and has permitted a representative of the said employees to
state the said employee’s case for them, the inquiry will be held collectively.

14 . Rights to Appeal

An employee has the right to appeal to a person appointed by the Company against any sanction. The
employee is entitled to have representation by a fellow employee and assistance from an interpreter if
requested. Such appeal must be lodged with the Chairperson of the original inquiry in the official form within
three (3) days of the decision on the appropriate company Appeal application form.

Depending on the reasons for the appeal, it can be held in the form of a full re-inquiry of the matter.
Which will take place within a reasonable time, normally five days, after receipt of the written appeal
application. If the reason for the appeal does not include the misconduct of the previous presiding officer,
the matter will not be open for re-inquiry.

If it is necessary, and if it is alleged that the previous Presiding Officer conducted an unfair procedure, was
biased in his office, or allowed non-submissable evidence, the Appeal Officer may decide that the appeal
should take the form of a review of the first disciplinary inquiry. The form that the appeal will take will be at
the discretion of the Chairperson of the appeal inquiry and will depend on the reasons for the appeal.

An employee is not contractually entitled to two inquiry’s. Furthermore, an Company is entitled to cure any
defect whether procedural or otherwise at the appeal inquiry.

____________________________
LABOUR MANAGEMENT SERVICES
P.O. Box 2462,
Hillcrest, 3650.
Tel: 031-765 1704
Cel: 072-588 2042

LABOUR MANAGEMENT
SERVICES
Labour Management Services - Code Procedure Revision 09/2007 © 6
 NOTICE TO ATTEND ENQUIRY

EMPLOYEE:________________

An enquiry will be held to investigate the alleged offence/s as detailed below:

NATURE OF COMPLAINT-

COMPLAINANT – ______________ CHAIRPERSON –______________________

The enquiry will be held on: DATE ____________ TIME: ________________________

I confirm that I have been advised of the following:

1. I am entitled to be assisted at the disciplinary enquiry by a fellow employee only. No outside representation
would be allowed. Securing representation is my responsibility
2. I am entitled to have an interpreter .
3. I am entitled to have the opportunity to confer with my representative before, during and after the enquiry.
4. I am entitled personally, or through my representative, to question the complainant and witnesses during the
enquiry.
5. I am entitled to furnish evidence, call witnesses and to argue on the question of whether the misconduct
occurred.
6. I am entitled to furnish evidence and to argue in mitigation of disciplinary action.
7. I have been advised that should I refuse/fail to attend the enquiry, the enquiry may be held in my absence.
8. I have been advised that I am entitled to lodge an appeal against the decision of the Disciplinary Enquiry within
three working days of the decision. The appeal must be lodged with the chairperson of the disciplinary enquiry and
must motivate fully the grounds of such appeal and whether such appeal is in respect of the decision and/or
sentence of the disciplinary enquiry. Any appeal will be heard as soon as possible of such notice being given.

EMPLOYEE ____________________________ WITNESS ______________________

(Employee refused to sign Yes \ No) DATE __________________________________

INTERPRETER (If required) I confirm that the entire contents of this document have been properly
interpreted to the Employee who confirms having fully understood the contents.

Interpreter : _______________________ Date: ____________

Company Witness: __________________________ Date: ____________

Employee Witness: __________________________ Date: ____________

Company to keep original signed copy .

Labour Management Services - Code Procedure Revision 09/2007 © 7

 LABOUR MANAGEMENT
SERVICES
RECORD OF GRIEVANCE / DISCIPLINARY ENQUIRY

Date _________________
PRESENT
Chairperson: ROARK RYAN

Complainant: Employee:

Witnesses for complainant Witnesses for employee

1. 1.

2. 2.

3. 3.

Interpreter: ______________________Representative: _______________________

If employee does not require either of the above, note and have employee/witness sign.

1. Employee's rights, as per the notification of enquiry to be explained.

2. Nature of alleged breach or misconduct (Charge, date, time, place and brief description of the
incident(s) –

3 Ask employee to Plea: Guilty / Not Guilty of the charges.

Employee / witness signature: _______________

4 Procedure of enquiry (to be explained by the Chairperson)

•. Ensure employee received notification and had time to prepare.

•. Charge to be put to accused
•. Accused to plea
•. The evidence of the complainant and his/her witnesses will be heard first. Witness only present
when giving evidence.
•. The employee/ representative and chairperson may ask questions of the evidence.
•. The employee and his/her witnesses may then give evidence and they may be asked questions
by the complainant and chairperson.
•. The chairperson will make a decision on guilt
•. Then only inspect the employee’s file,
•. Closing argument , hear mitigation
•. Then decide what action to take and inform employee
•. Advise employee of right to appeal / declare dispute

Complainant’s & Witnesses evidence – Point form

Labour Management Services - Code Procedure Revision 09/2007 © 8

Labour Management Services - Code Procedure Revision 09/2007 © 9
Accused evidence Witnesses – Point form

Labour Management Services - Code Procedure Revision 09/2007 © 10

NB: Ask employee and record response
• Are you satisfied that the inquiry was conducted fairly.
• Did you have a fair opportunity to state your case ask questions and call witnesses.
• Are you satisfied with the procedure followed in the inquiry .
• Would you like to check the record
• Does the record reflect proceedings
• Is there anything about the inquiry that you are not satisfied with

Chair / Employee Comment / Response

The Employee is satisfied / not satisfies with proceedings.

Employee / witness signature: _______________

FINDINGS OF INQUIRY:

BEFORE THE CHAIRPERSON COMES TO A DECISION CONSIDER THE FOLLOWING;

• Always be honest and fair. How would the chairperson like to be treated?
• Did the employee know the rule or regulation and was it broken was broken? If the chairperson is not
sure, give the employee the benefit of the doubt.
• Do not let emotions dictate guilt or innocence, this can never be an emotional decision. If the
chairperson is not sure, postpone finding, to allow more time to consider evidence presented, give the
employee the benefit of the doubt.
• If the complainant cannot prove alleged transgression it is not the chairpersons responsibility to guess
what happened. Base decision on fact, not hearsay. Measure of guilt is “ on the balance of probabilities”
• The primary reason for an enquiry it to establish if a transgression occurred and to correct behaviour, not
to dismiss employees.

FACTS ESTABLISHED

GUILTY / NOT GUILTY. (Delete not applicable)

Labour Management Services - Code Procedure Revision 09/2007 © 11

Inform and explain finding to employee:

Employee / witness signature: ___________

1. ...... REVIEW OF RECORD

Previous Warnings Warning level Valid / Not valid

2. ...... CLOSING ARGUMENT , MITIGATING FACTORS & SUBMISSIONS ON PENALTY

Date of employment: __________________Dependants: ______________________

3. ...... CLOSING ARGUMENT AGGRAVATING FACTORS & REPRESENTATIONS ON PENALTY

Counselling Training Verbal Written Final Dismissal Dismissal

Warning Warning Warning With Without
Notice Notice

OR

Suspension With Pay Suspension Without Pay, Note this can only be done by obtaining
the employees agreement.
I _______________________ agree to be suspended from work
from ________________ to ____________ without pay as a last
alternative to dismissal. From ____________ to
_______________
Acceptance:
Employee (Sign)____________Date: _________

Sanction Imposed: Warning valid from date of offence to __________________

Labour Management Services - Code Procedure Revision 09/2007 © 12

Reasons for sanction:

NB: Inform employee as to:

• . Right of Appeal, Employee intends to appeal YES / NO / UNDECIDED.

• . Right to refer dispute to the CCMA if employee feels unfairly treated, CCMA contact Number 011
3776600 (Commonly only in dismissal matters)

NOTE: Signature records employee’s understanding, not necessarily acceptance of findings

Employee/Witness: (Signature)_________________Date: _______________

Chairperson: (Signature)________________ Date: _________________

If Required

INTERPRETER: I confirm that the entire contents of this document have been properly interpreted to the
Employee who confirms having fully understood the contents.

Interpreter: _______________________ Date: ____________

Company Witness: __________________________ Date: ____________

Employee Witness: __________________________ Date: ____________

Labour Management Services - Code Procedure Revision 09/2007 © 13

 LABOUR MANAGEMENT
SERVICES
LODGING OF APPEAL

TO_________________________________________________________________

In terms of the disciplinary procedures, I wish to lodge an appeal against the decision of the disciplinary
panel (within three working days).

NAME OF APPELLANT:________________________________________________

The appeal is made on the following grounds (The appropriate areas to be marked with an X)

1 The penalty imposed was not commensurate with the breach of the disciplinary code.
2 Disciplinary procedures were not followed.
3 New or further evidence or witnesses are available, which could bring new facts to bear and which
could affect the result of the previous inquiry.

The following reasons are submitted in support of this appeal application:

Date appeal lodged ....... ......... .......... ......... ......... Appellant’s Signature ………………….

_____________________ DATE Received : ________________

Company

Employee granted right to appeal / Employee refused right to appeal

Date informed : ____________________ Employee / witness signature : ___________________

Reasons

Labour Management Services - Code Procedure Revision 09/2007 © 14

 LABOUR MANAGEMENT
SERVICES
Dear ;___________________

SUSPENSION FROM DUTY :

You are further advised that you have been suspended from duty with / without full pay

from .......…………... (time) on ......………….. (date)

until …………....…... (time) on …………......... (date).

Reason for suspension :

Should you wish to appeal against this suspension your written representation must reach the Company
within 24 hours of this notice.

During your period of suspension, you will not be permitted on the Company's premises unless written
permission has been given to you by ____________ or for attending this investigation.

Employee : ___________________ Company : ____________________

INTERPRETER (If required) I confirm that the entire contents of this agreement have been properly
interpreted to the Employee who confirms having fully understood the contents.

Interpreter : _______________________ Date: ____________

Company Witness: ____________ Date: ____________Employee Witness: _______________

Comment

Labour Management Services - Code Procedure Revision 09/2007 © 15

 LABOUR MANAGEMENT
SERVICES
FULL AND FINAL SETTLEMENT AGREEMENT

I, ________________________________ acknowledge receipt of the following in full and final settlement of

all and any claims and / or disputes which may arise now or in the future as a result of the termination of my
contract of employment with ____________________________.

I confirm that I have not been forced or persuaded in any way to accept this FULL AND FINAL
SETTLEMENT AGREEMENT and do so of my own free will.

Outstanding Salary

Notice

Leave Pay

LESS DEDUCTIONS

TOTAL

SIGNED: …………………… Employee ......... ......... …………. .... Date ……………..

Witness ....... ......... ......... ......... .......... ......... ......... ......... Date…………………………

INTERPRETER (If required) I confirm that the entire contents of this agreement have been properly
interpreted to the Employee who confirms having fully understood the contents.

Interpreter : _______________________ Date: ____________

Company ______________________ Date : _______________________

Comment

Labour Management Services - Code Procedure Revision 09/2007 © 16

 LABOUR MANAGEMENT
SERVICES
UNDER THE INFLUENCE VERIFICATION PROCEDURE
1. Call an independent witness, an alternative employee representative.

2. Complete the details listed below.

Employee Name : __________________ Co. No.: __________________

Management Witness:______________ Employee Witness ______________

Breath smells of alcohol strongly Faintly no smell

Speech is slurred very Slightly not
Movements of limbs un-coordinated slightly un- coordinated normal
Walking / balance is: uncontrolled slightly coordinated coordinated
Eyes are bloodshot slightly bloodshot normal
Employees expression dazed slightly dazed normal

3. In my opinion this employee is FIT / NOT FIT to continue working.

4. General observation and comment Date ________________ Time : _________

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

EMPLOYEE COMMENT
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

If the observer decides that the employee is under the influence of alcohol or any other
narcotic substance the employee is to be ordered off Company premises and must be
instructed to return to work the following working day, to be issued with a notice to attend a
disciplinary enquiry

Employee / Witness: ______________Date : ___________Company : _______________

INTERPRETER (If required) I confirm that the entire contents of this document have been properly
interpreted to the Employee who confirms having fully understood the contents.

Interpreter : _______________________ Date: ____________

Labour Management Services - Code Procedure Revision 09/2007 © 17

LABOUR MANAGEMENT
SERVICES
DATE :_______________________

Dear _____________________

WRITTEN / FINAL WRITTEN WARNING

This letter serves to confirm our discussion / counselling / enquiry held on

regarding ;

Such conduct is in conflict with the rules of the organisation and you are therefore given a
written warning that, should this behaviour recur, further disciplinary steps will be taken,
which could lead to your dismissal.

Please note this warning will be valid for a period of _______.

Name of Manager Signature

I, , hereby acknowledge receipt of this letter and confirm that I

understand the content. I further understand that should I in any way disagree with the
content of this warning I have the right to appeal.

Employee Signature Date

Labour Management Services - Code Procedure Revision 09/2007 © 18