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Performance Management

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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:

Team Member Name *

Employee ID *

Date of Occurrence *

Type of Record *

Verbal Warning

Written Warning: First

Written Warning: Second

Written Warning: Final

Termination

Department *

Team Lead Name *

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

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

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

Suggested Means of Improvement: *
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.

Manager Signature *

Clear

Witness Signature *

Clear

Employee Signature

Clear

Employee Refused To Sign

Check Here

Team Member Comments
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).

Additional Documentation
Any supporting documentation from the incident

Additional Documentation
Any supporting documentation from the incident

Counseling Record

Click Submit to finish.