• Prepared by

  • Conducted on

Personal Details

  • Surname

  • First Name

  • Contact number

  • Current Site

  • Classification

  • Specific Position (labourer etc)

You are only required to fill out one of the following two sections, either 'Resignation Details' or 'Dismissal Details'.

Resignation Details

  • Date notice was given

  • Number of days' notice was given

  • What is their last working day

  • Did they work out their notice


  • Please specify to be followed up by HR (flights, courses, etc.)

Dismissal Deatils

  • Was the employee given notice

  • If so, what date

  • How much notice was given

  • What is their last working day

  • Reason for Dismissal

  • Provide Details

Performance Report - MUST BE COMPLETED

  • Standard/Performance
    1-2 Unacceptable
    3-4 Poor
    5-6 Acceptable
    7 Good
    8 Very Good
    9 High
    10 Excellent

  • Safety

  • Comments

  • Attendance

  • Comments

  • Attitude

  • Comments

  • Ability

  • Comments

  • Flexibility

  • Comments

  • Output

  • Comments

  • Is this person suitable for re-employment in the future

  • Additional Comments

  • Supervisor/Senior Management Signature

Stored in Employment Directory

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.