CONFIDENTIAL
SOUTHSIDE COMMUNITY SERVICES BOARD
Employee Corrective Action Plan
INSTRUCTIONS:
This plan is to be completed by the first-line supervisor within ten (10) workdays of notification
to employee that there is a deficiency or deficiencies in their job performance. The completed
plan may incorporate input from the employee and is to be reviewed with them prior to its
implementation.
The supervisor will provide completed copies to:
●
Employee
●
Employee's Immediate Supervisor
●
Disability Supervisor
●
Executive Director
●
Human Resource Office
PART I:
GENERAL INFORMATION
●
Employee's
Name:____________________________________________________________
First
Middle
Last
●
Reason for Corrective Action Plan (check one)
Unsatisfactory Performance Evaluation
Critical Job Performance Incident
Employee Standards of Conduct Violation
Other (Please provide explanation(s)
_________________________________________________________________
_________________________________________________________________
PART II:
CORRECTIVE ACTION TIMEFRAMES
●
Implementation Date
________
Month
Day
Year
●
Completion Date
________
Month
Day
Year
PART III:
SIGNATURES/DATES
●
Employee: _____________________________________________________________
Name
Position Title
Work Unit
Date
●
Supervisor: _____________________________________________________________
Name
Position Title
Work Unit
Date