Performance Management Records

Counseling Record

Purpose: To provide a formal opportunity for a supervisor to help an employee understand where improved performance is/was expected, and to provide a written record of each counseling session:

Team Member Name *

Employee ID *

Date of Occurrence *

Type of Record *

Verbal Warning

Written Warning: First

Written Warning: Second

Written Warning: Final

Termination

Department *

Team Lead Name *

Problem Definition: *

List below specific reason(s) why this person is being counseled and the impact the problem has on the company.

Prior Warnings: *

(verbal or written) occurred on the following date(s) and involved the following facts and circumstances:

Improvement Required *

List below specific actions the employee must take to correct the situation or behavior.

Suggested Means of Improvement: *

List below specific goals, objectives and measurement standards that you and the employee have agreed to, and in what time frame.

Failure to comply with the above within the specified period, or further violations of company policies and procedures will result in further disciplinary action up to and including termination.

Manager Signature *

Witness Signature *

Employee Signature

Employee Refused To Sign

Team Member Comments

Should the employee disagree with any of the information contained in this counseling record the employee may submit a written statement explaining his or her position below (attach additional pages as necessary).

Additional Documentation

Any supporting documentation from the incident

Additional Documentation

Any supporting documentation from the incident

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Counseling Record

Counseling Record

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