COUNSELING FORM
Employee Name _________________________________________
Date _____________
Department ___________________________________________________________________
Position ______________________________________________________________________
Date of Incident _________________________________________
Time ____________
Reason for Counseling: _________________________________________________________
_____________________________________________________________________________
Details of What Happened: _____________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What is Wrong? How action effects operations? ____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What must be done to correct problem? __________________________________________
_____________________________________________________________________________
Employee's Comments: ________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Supervisor's Comments: _______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Employee's Signature _____________________________________
Date ____________
Supervisor's Signature ____________________________________
Date ____________
Q:\HR\FORMS\COUNSELING.DOC