Employee Counseling Form - Life University printable pdf download

Employee Counseling Form

Employee Name __________________________________________________________________________________

Date of Notice ____________________________________ Date of Violation _________________________________

Nature of Violation

Poor Performance

Insubordination

Absence/Tardiness

Falsification of Documents/Records

Violation of Company Policy

Harassment

Other _________________________________________________________________________________________

Action Taken

Verbal Warning

Suspension

Written Warning

Termination

Other _________________________________________________________________________________________

Summary of Violation

(Attach any additional documentation)

_________________________________________________________________________________________________

Summary of Corrective Plan of Action

(Attach any additional documentation)

_________________________________________________________________________________________________

Follow up date(s) __________________________________________________________________________________

Employee Signature _______________________________________________________ Date ____________________

Supervisor/Manager Signature ______________________________________________ Date ____________________

Human Resources Received _________________________________________________ Date ____________________

The University reserves the right to begin the performance improvement process at any level. Under appropriate circumstances,

suspension may be immediate. The form of discipline depends on the circumstances, including performance, attendance, and

behavior issues.

The employee signature is intended only to acknowledge receipt of the notice; it does not imply agreement or disagreement

with the notice itself. If the employee refuses to sign, the supervisor/manager will be asked to initial the form indicating that the

employee received a copy of the form.

rev. 6/06

Employee Counseling Form - Life University