Title Page

  • Conducted on




Corrective Action


  • Facts - List only facts, not opinions. Give concrete examples, when possible, to document the incorrect behavior. Note: This can not be about attitude, must be tangible.

  • Objectives – What is the desired outcome? What do you expect? You may want to cite a portion of the job description or a policy.

  • Solutions – How do you suggest that he or she improves their performance? Does the employee have any suggestions? You may offer additional training, review of procedures, etc.

  • Action – Tell the employee in writing that he or she is receiving a warning, suspension, etc. and set a date to review his or her progress towards obtaining the goals set.

Directions for Submitting the Corrective Action Form: Please use additional forms if the employee has more than one area that needs improvement. The employee must sign the Corrective Action form to acknowledge receipt. If the employee refuses to sign, write “refused to sign” and sign your name as a witness. The supervisor should give a copy of the signed document to the employee and send the original to the Human Resources office via "South Incidents", "West Incidents", or "Nitrogen Incidents". The Corrective Action will be placed in the personnel file.

  • List any follow-up actions and due date:

  • Employee Signature

  • Supervisor Signature

  • Witness Signature

  • HR Manager Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.