Employee Counseling Form
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Employee Counseling Form
Counseling Date: __________
Employee’s Full Name: ________________

Job Title: _______________

Worksite Employer: _________________

Location: _______________

This Counseling is being issued because of the following (Select all that apply):
____ Attendance

____ Behavior/Teamwork ____ Inappropriate Conduct

____ Inappropriate Dress ____ Safety Violation

____ Sleeping on the Job

____ Substandard Work

____ Other _________________

____ Violence

Incident Date: _________________

Time of Incident: __________________

Describe the nature of the incident (If applicable):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Name of Witness(es):
______________________________________________________________________
Corrective Action:
______________________________________________________________________
__