Information

  • Store #

  • Date of counseling

  • Prepared by

  • Location
  • Employee name

  • Date of Occurrence

  • Action Taken

  • Type of occurrence

  • Describe Issue/Conduct to be Addressed

  • Describe Expected Conduct

  • Employee Comments

  • If unacceptable conduct continues further action may be taken, up to and including termination of employment. I understand that signing this document merely indicates that I have been advised of the action taken and the possible future action(s) My signature does not indicate agreement with counseling.

  • Employee

  • Manager/Supervisor

  • Witness

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.