"Confidential Employee Corrective Action Form"

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Confidential Employee Corrective Action Form
Unsatisfactory Conduct
Unsatisfactory Performance
Employee Name ________________________________________ Date _____________________
Employee Number ____________________________ DOH: ___________ Location ___________
Type of Action Warranted:
Coaching
Counseling
Written
Final
Policy Violation or Performance Issue – Listed below is the policy(s) that was violated, date, and
time or standard of performance that you have not met.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Conduct that was observed and/or substantiated:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Below are areas of your performance/conduct which need to improve to Satisfactory level or better
and suggestions for improvement or immediate action that needs to take place.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
If performance and/or conduct does not improve, further disciplinary action could occur up
to and including termination. ________
employee initials
List all previous warning(s):
Date: ________________ Date: ________________ Date: ________________
Type: ________________ Type: ________________ Type: ________________
Employee Signature ______________________________________
Date
______________
This information has been reviewed with me
Supervisor Signature ______________________________________
Date
______________
Administrator/Mgr Signature___________________________________ Date ______________
HR 200
11/07
Confidential Employee Corrective Action Form
Unsatisfactory Conduct
Unsatisfactory Performance
Employee Name ________________________________________ Date _____________________
Employee Number ____________________________ DOH: ___________ Location ___________
Type of Action Warranted:
Coaching
Counseling
Written
Final
Policy Violation or Performance Issue – Listed below is the policy(s) that was violated, date, and
time or standard of performance that you have not met.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Conduct that was observed and/or substantiated:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Below are areas of your performance/conduct which need to improve to Satisfactory level or better
and suggestions for improvement or immediate action that needs to take place.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
If performance and/or conduct does not improve, further disciplinary action could occur up
to and including termination. ________
employee initials
List all previous warning(s):
Date: ________________ Date: ________________ Date: ________________
Type: ________________ Type: ________________ Type: ________________
Employee Signature ______________________________________
Date
______________
This information has been reviewed with me
Supervisor Signature ______________________________________
Date
______________
Administrator/Mgr Signature___________________________________ Date ______________
HR 200
11/07