Workplace Write-Up Rebuttal Statement PDF

Capture your side of the story with a rebuttal summary, event timeline, and evidence references you can print or share.

Employee name

Employee ID (optional)

Job title

Department

Employer

Manager (optional)

Write-up date

Incident date

Policy or reason cited

Rebuttal summary

Timeline of events (one per line)

Evidence references (one per line)

Requested outcome

Include a truthfulness attestation

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