Clinical Support Services (Css) Corrective Action Report printable pdf download

Clinical Support Services (CSS) Corrective Action Report

Employee Name (Last/First/MI): ___________________

Banner ID: _____________________

Position Title: ___________________________________

Department: ____________________

⁭ Temporary

⁭ Probationary

⁭ Time-Limited

⁭ Permanent

Employee Status

Type of Action:

⁭ Written record of verbal warning or performance improvement discussion

⁭ Written Warning

⁭ Final Written Warning

⁭ Demotion

⁭ Suspension

⁭ Investigatory Leave

⁭ Dismissal

⁭ Unsatisfactory Job Performance

⁭ Gross Inefficiency

⁭ Unacceptable Personal Conduct

Issued for the following:

Date of Incident (if applicable): _________________________

Details of incident (please indicate work rule violated or areas of deficiency):

____________________________________________________________________________________________________________

Corrective Action Expected of Employee or Performance Improvement Plan (if applicable):

____________________________________________________________________________________________________________

Previous Corrective Actions (Date/Type of Action):

____________________________________________________________________________________________________________

Subsequent Corrective Actions for Future Work Rule Violations (up to and including):

⁭ Written Warning

⁭ Final Written Warning

Employee Relations Review:

⁭ Demotion

⁭ Suspension

________________________________________________________________________

⁭ Dismissal

(Date)

Supervisor Signature _________________________________________________________________________________________

(Date)

(acknowledgement does not constitute agreement): Copy of Corrective Action Report given to employee ⁭

mployee Acknowledgment

Employee Refused to Sign ⁭

_______________________________________________________________

(Date)

Corrective Action Reports remain active for 18 months unless additional corrective action is necessary.

Otherwise, they remain a part of the employee’s personnel file and may be taken into consideration in determining progression of steps if future corrective

action is necessary. Active disciplinary actions may result in an overall annual performance rating of “below expectations”. Additionally, an overall annual

performance rating of “meets expectations” or better does not render any active disciplinary actions as inactive.