What does this form do? An Employee Counseling Form is used to notify an employee of a company's demand that they seek professional help for issues that are hindering their work performance.What is the Name of the Employee that is subject to counseling? Employee's Name First Last Job Title What Job Title does the employee hold? Job Title Employer What Company/Employer does the employee work for? Employer Address Enter the employee's mailing address. Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Enter employee's address. Reason for Counseling Counseling is being issued due to which of the following? (Check all that apply) Counseling is being issued due to which of the following? (Check all that apply) AttendanceBehavior/TeamworkInappropriate ConductInappropriate DressSafety ViolationSleeping on the JobSubstandard WorkViolenceOther Please check all that apply. Other Nature of Incident Would you like to describe the nature of incident(s) that occurred? Would you like to describe the nature of incident(s) that occurred? YesNo Description of Incident(s) Witnesses Please enter a page description. Would you like to include any witnesses to the incident(s)? Would you like to include any witnesses to the incident(s)? YesNo Witness(es) Include Names and Phone Numbers of all Witnesses. Hours How many hours of counseling must the employee complete? How many hours of counseling must the employee complete? Enter a number of hours. Completion At what date must the employee complete their counseling hours? Completion Date Corrective Action Give details as to where the employee must go in order to obtain counseling and how they must go about correcting the issue(s) in the future. Corrective Action Please enter some text to the area above. Authorization Who will be the authorized person in charge of serving the employee this form? First Last Signature eSign this document now or leave blank to sign at a later by hand. Signature of Authorization Clear Please draw your signature. Please write your signature to the area above. Next Save Save and finish later
