Performance Review - Local

• Document No.

• Jobsite

• Issued by

• Location
  Address

• Employee name

• Position

  Helper

  Apprentice

  Journeyman

  Supervisor

  PM

• Reporting Manager

Purpose: To provides formal opportunity for a supervisor to help and employee understand where improved performance is expected, and to provide a written record of each counseling session

• Select One

  Select Counseling Session Verbal Warning Written Warning Final Written Warning Suspension Monetary Fine

  • Counseling Session
  • Verbal Warning
  • Written Warning
  • Final Written Warning
  • Suspension
  • Monetary Fine

• Amount

  $50

  $75

  $100

  $125

• There is no requirement that all steps in the discipline progression must be followed; the company has discretion to decide on the penalty depending on the nature of the offense.

Problem Area (Note below specific problems, issues, occurrences, dates, times, etc.)

• Select one

  Select Disregard supervisor/co-worker/client/customer absenteeism / Tardiness Failure to do a job Gross misconduct failure to comply with company policy and/or procedure other specify

  • Disregard supervisor/co-worker/client/customer
  • absenteeism / Tardiness
  • Failure to do a job
  • Gross misconduct
  • failure to comply with company policy and/or procedure
  • other specify

• Note below specific problems

• Specific problem visual aid (if available)

  Media

PROBLEM DEFINITION

• List the specific reason(s) why this person is being counseled.

IMPROVEMENT REQUIRED

• List specific actions the employee must take to correct the situation or behavior.

SUGGESTED MEANS OF IMPROVEMENT

• List specific goals, objectives and measurement standards that you and the employee had agreed to, and in what time frame.

• FAILURE TO COMPLY WITH THE ABOVE REQUIREMENTS IN THE SPECIFIC PERIOD, OR FURTHER VIOLATIONS OF COMPANY POLICIES AND PROCEDURES MAY RESULT IN FURTHER DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION.

• EMPLOYEE COMMENTS:

• Was this counseling decision discussed with an Human Resources Professional.

• I acknowledge that I have discussed this warning/acknowledgement with the employee, set an action plan and had given him/ her a copy (if so asked) and the original signed copy has been recorded in the employees personnel file.

• Supervisor Signature

  Sign

• Safety Director Signature

  Sign

• I acknowledge that this issue or problems were discussed with me and I may receive a copy if requested and that this will also become part of my personal record.
  
  I acknowledge that failure to correct the situation within the time frame indicated will result in further disciplinary action up to including termination of employment.

• Employee Signature

  Sign