HR-006H-03

St. Elizabeth Hospital, Inc.

General Santos City

Human Resource and Development

NOTICE OF CHARGE
A. Employee : ARAT, MARC LAWRENCE C. I.D. No. : 60636 Date : FEB. 29, 2012
Position : STAFF NURSE Date Hired : OCT. 18, 2010 Time : 05:58PM
Section : NS – 1A Department : NURSING SERVICE OFFICE

This Notice of Charge officially records that you are hereby charged with a violation of the Hospital’s Code of Discipline/Rules and
Regulation as follows:

B. STATEMENT OF FACTS

 MEDICATION ERROR

C. OFFENSE CHARGED AND APPLICABLE PENALTY

 CODE OF DISCIPLINE NO. IV SECTION 1 NEGLIGENCE, CARELESSNESS AND/OR GROSS INEFFICIENCY IN THE
PERFORMANCE OF DUTIES.

> SANCTION : FIRST OFFENSE – FIFTEEN (15) WORKING DAYS SUSPENSION.

D. ORDER TO EXPLAIN

Please explain in writing within a period of FIVE (5) day/s why no disciplinary penalty should be imposed against you for the
above mentioned offenses.

Charging Officer:
MR. BENJAMIN A. TORRIJOS, DVM ______________
Immediate Supervisor Date

Acknowledged Receipt (This does not mean acceptance of the charge/s)

________________________________ ______________
Name/Signature of Employee Date

E. EMPLOYEE EXPLANATION (Please use the Incident Report Form). Failure to submit an explanation within the period
indicated above shall constitute a waiver of your right to be heard and the matter shall be submitted for resolution based on the
records at hand.)

F. DECISION/ACTION TAKEN ON THE ABOVE MENTIONED CHARGE

 CODE OF DISCIPLINE NO. IV SECTION 1 NEGLIGENCE, CARELESSNESS AND/OR GROSS INEFFICIENCY IN THE
PERFORMANCE OF DUTIES.

> SANCTION : FIRST OFFENSE – FIFTEEN (15) WORKING DAYS SUSPENSION.

Recommended By:

MR. BENJAMIN A. TORRIJOS, DVM ______________ APPROVED BY:

Immediate Supervisor Date
___________________________ __________
Acknowledged Receipt: Human Resource Officer Date

Decision Accepted For Grievance

MR. MARCELINO E. DOSPUEBLOS, CPA __________
Administrator Date
________________________________ ______________
Name/Signature of Employee Date