Employee Counseling Form

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Employee Counseling Form

An employee counseling form is used by a supervisor to address an issue with an employee’s behavior or performance. The document is completed by the parties after discussing the matter privately to outline its causes and emphasize the remedies that the employee must make.

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Last updated July 18th, 2025

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An employee counseling form is used by a supervisor to address an issue with an employee’s behavior or performance. The document is completed by the parties after discussing the matter privately to outline its causes and emphasize the remedies that the employee must make.

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Counseling an Employee

Counseling addresses emerging issues and can help avoid the need for disciplinary action. It allows the supervisor to voice concerns and for the employee to share any causes behind a change in conduct.

State laws, local rules, and union agreements must be respected when counseling. For example, California employees must be notified of documents related to their performance (such as a counseling form) and receive a copy.[1]

Benefits

  • Allows employers to take a problem-solving approach to a staff issue.
  • Less confrontational than issuing a warning or reprimand.
  • Fosters an open and supportive workplace environment.

Sample

PDF, MS Word, ODT

EMPLOYEE COUNSELING FORM

EMPLOYEE INFORMATION

Employee Name: [EMPLOYEE NAME] Employee Department: [EMPLOYEE DEPARTMENT]
Employee Title: [EMPLOYEE TITLE]  Employee ID #: [EMPLOYEE ID #]
Supervisor Name: [SUPERVISOR NAME]  Date: [MM/DD/YYYY]

COUNSELING REASONS

This counseling form is being issued due to the following:

☐ Attendance
☐ Dress code
☐ Performance
☐ Behavior
☐ Teamwork
☐ Safety
☐ Violence
☐ Conduct
☐ Other: [REASON]

When did the incident happen?: [INCIDENT DATE/TIME]
Details of actions: [INCIDENT DETAILS]

CORRECTIVE ACTIONS

The following corrective action must be taken by the employee. Failure to do so will result in further disciplinary action, up to and including termination:
[CORRECTIVE ACTIONS]

EMPLOYEE COMMENTS

Enter any comments the employee has regarding the incident:
[EMPLOYEE COMMENTS]

ACKNOWLEDGMENT

The employee’s signature below confirms that the employee intends to immediately correct their actions as discussed in this document. Failing to do so may result in further disciplinary action, up to and including termination of employment.

Employee Signature:                                                               Date: ______________
Print Name:[EMPLOYEE NAME]

Supervisor Signature:                                                               Date: ______________
Print Name:[SUPERVISOR NAME]

Sources

  1. § 1198.5 (a)