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DISCIPLINARY ACTION CHECKLIST - IAFC

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SAMPLE GARRITY WARNING<br />

I. At this time, I am going to question you regarding:<br />

___________________________________________________________<br />

___________________________________________________________<br />

II.<br />

III.<br />

IV.<br />

This questioning concerns administrative matters relating to the XYZ Fire<br />

Department. During the course of this questioning, if you disclose<br />

information which indicates that you may be guilty of criminal conduct,<br />

neither your self-incriminating statements nor the fruits of any selfincriminating<br />

statements that you make will be used against you in a<br />

criminal legal proceeding, except your statements may be used related to<br />

perjury or impeachment.<br />

Because this is an administrative matter, you are required to answer my<br />

questions fully and truthfully. Your statements may be used against you<br />

regarding your ability to carry out your job functions and for disciplinary<br />

purposes.<br />

You are entitled to all rights and privileges guaranteed by the Arizona<br />

Constitution and the United States Constitution. You may have an attorney,<br />

union representative or another employee present with you during this<br />

interview.<br />

V. If you refuse to answer all of my questions, you will be subject to a<br />

separate disciplinary action for insubordination.<br />

VI.<br />

VII.<br />

Do you understand the foregoing?<br />

Employee initial: Yes ____ No ____<br />

Do you have any questions about your obligation to answer my questions?<br />

Employee initial: Yes ____ No ____<br />

I, ________________________________, by my signature below, affirm that I<br />

have been advised of the Garrity Warnings and had its meaning explained to me<br />

as set forth above.<br />

Employee: ___________________________________<br />

Date____________<br />

Officer signature: ______________________________<br />

Print name: ___________________________________<br />

Officer signature: ______________________________<br />

Print name: ___________________________________<br />

Date____________<br />

Date____________<br />

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