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:

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

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

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

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.


Clear

Clear

Clear

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).

Any supporting documentation from the incident

Any supporting documentation from the incident

search close