Counseling Memo Template

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COUNSELING MEMO TEMPLATE - Should be printed on department letterhead.
To:
From:
Date:
Subject:
Counseling Memorandum
The purpose of this memo is to document the issue(s) discussed at our meeting today. In
our meeting we discussed
(example: your unsatisfactory performance of assigned
duties).
PROVIDE SPECIFIC INFORMATION HERE ABOUT DEFICIENCIES. If the issue is
attendance – give the dates when the employee arrived late or called off without notice.
If the issue is unsatisfactory performance, describe the incident and what the employee
did or failed to do. If the issue is disruptive behavior, describe the setting and what the
employee said or did.
PROVIDE INFORMATION ABOUT PRIOR DISICPLINE ABOUT THIS ISSUE.
Indicate meetings you have had and/or training and coaching provided on these tasks,
reminders provided, etc. You may want to cut and paste a specific section(s) from the
position description into the memo that describe the job expectation that is not being met.
The Standards of Conduct Policy #1.60 states the following expectation: Example: Meet
or exceed established job performance expectations.
Immediate, consistent, and
sustained improvement is required in order to support the efficient operation of our
department. Continued unsatisfactory work performance will be grounds for formal
disciplinary action.
Below are recommended action steps to improve your performance in each area listed
above:
1.
.
2.
If there is anything that I can do to assist you in making the necessary improvements,
please let me know.
_______________________________
_______________________________
Employee’s Signature
Supervisor’s Signature
______________________________
_______________________________
Date
Date
COUNSELING MEMO TEMPLATE - Should be printed on department letterhead.
To:
From:
Date:
Subject:
Counseling Memorandum
The purpose of this memo is to document the issue(s) discussed at our meeting today. In
our meeting we discussed
(example: your unsatisfactory performance of assigned
duties).
PROVIDE SPECIFIC INFORMATION HERE ABOUT DEFICIENCIES. If the issue is
attendance – give the dates when the employee arrived late or called off without notice.
If the issue is unsatisfactory performance, describe the incident and what the employee
did or failed to do. If the issue is disruptive behavior, describe the setting and what the
employee said or did.
PROVIDE INFORMATION ABOUT PRIOR DISICPLINE ABOUT THIS ISSUE.
Indicate meetings you have had and/or training and coaching provided on these tasks,
reminders provided, etc. You may want to cut and paste a specific section(s) from the
position description into the memo that describe the job expectation that is not being met.
The Standards of Conduct Policy #1.60 states the following expectation: Example: Meet
or exceed established job performance expectations.
Immediate, consistent, and
sustained improvement is required in order to support the efficient operation of our
department. Continued unsatisfactory work performance will be grounds for formal
disciplinary action.
Below are recommended action steps to improve your performance in each area listed
above:
1.
.
2.
If there is anything that I can do to assist you in making the necessary improvements,
please let me know.
_______________________________
_______________________________
Employee’s Signature
Supervisor’s Signature
______________________________
_______________________________
Date
Date
Signing this form does not imply that you agree with the action taken, only that you are
acknowledging receipt of this counseling memo.
cc:
Kathy Williamson, Employee Relations Manager

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