Performance Improvement Plan

GENERAL INFORMATION

  • Employee Name

  • Date of Notice

PLAN DETAILS

  • Frequency

  • Severity

  • Start Date

  • End Date (Return to Work Date)

  • Amount

  • Nature of Improvement Required

  • Specifically

  • Details of Incident(s) - Please be as specific as possible

  • Please attach any relevant photos or files

  • Details of Improvement(s) Required - Please be as specific as possible

  • Expected Completion Date

  • Completed By

  • An employer witness was used for this conversation

  • Employer Witness

  • Specifically

  • Details of Incident(s) - Please be as specific as possible

  • Please attach any relevant photos or files

  • Details of Improvement(s) Required - Please be as specific as possible

  • Expected Completion Date

  • Completed By

  • An employer witness was used for this conversation

  • Employer Witness

  • Specifically

  • Details of Incident(s) - Please be as specific as possible

  • Please attach any relevant photos or files

  • Details of Improvement(s) Required - Please be as specific as possible

  • Expected Completion Date

  • Completed By

  • An employer witness was used for this conversation

  • Employer Witness

  • Specifically

  • Details of Incident(s) - Please be as specific as possible

  • Please attach any relevant photos or files

  • Details of Improvement(s) Required - Please be as specific as possible

  • Expected Completion Date

  • Completed By

  • An employer witness was used for this conversation

  • Employer Witness

  • Specifically

  • Details of Incident(s) - Please be as specific as possible

  • Please attach any relevant photos or files

  • Details of Improvement(s) Required - Please be as specific as possible

  • Expected Completion Date

  • Completed By

  • An employer witness was used for this conversation

  • Employer Witness

  • Specifically

  • Details of Incident(s) - Please be as specific as possible

  • Please attach any relevant photos or files

  • Details of Improvement(s) Required - Please be as specific as possible

  • Expected Completion Date

  • Completed By

  • An employer witness was used for this conversation

  • Employer Witness

EMPLOYEE ACKNOWLEDGEMENT

  • I have read and understand this notice. I am aware that further disciplinary action, up to and including termination of employment, may result if a similar incident occurs in the future.

  • I AGREE with this notice.

  • I DISAGREE with this notice.

  • Employee disagreements will be taken into consideration but the details of the Improvement Plan remain in effect until/unless a written modification is issued from the employer.

  • Employee explanation is required. Please include all relevant details.

  • Employee

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