SUPPORT EMPLOYEE PERFORMANCE CORRECTION NOTICE

Section I – Background Information

Employee Name: Department/School:

Classification: Supervisor:

Date of Meeting: Date of Hire:

Date Issued: Is Employee on Probation:

Employee’s ID:

Disciplinary Level Request: Written Warning Written Reprimand Suspension

Request for Termination

Description of Current Incident(s) or Violation(s):

(a)  Date -

(b)  Time -

(c)  Place -

(d)  Witness(s) –

(e)  Organizational Impact -

(f)  Violation(s) -

Prior Personnel Action(s):

Date / Form / Comments

Section II - Incident Description and Supporting Details

Attendees:

(a)  Attending for Management:

(b)  Attending for Management:

(c)  Attending for Employee:

(d)  Employee Representative:

Statements Presented:

Management:

Employee:

Decision:

Consequences: is advised that future incidents of unsatisfactory job performance will result in progressive disciplinary action up to and including termination.

Scheduled Suspension Date(s): Suspension to begin at the beginning of work day and to be completed at the end of the workday . Employee is to return to work on .

Section III - Performance Improvement Plan:

1. Measurable/Tangible Improvement Goals:

2. Training or Special Direction Provided:

3. Interim Performance Evaluation Necessary:

4. Our Employee Assistance Program (EAP) Deer Oaks EAP Services can be confidentially reached to assist you at (1-800) EAP-2400; this is strictly voluntary. A booklet regarding the EAP’s services is available from Human Resources.

Section IV - Employee Acknowledgment

I understand that my signature below does not reflect my agreement/disagreement to any of the issues raised. My signature verifies that I have seen this document and received a copy. I also understand that I may write a rebuttal and that my comments will be placed in my personnel file along with this documentation.

______

Employee Signature Date Supervisor Signature Date

You may file a written appeal to this action to located at . The appeal must be received within () workdays of receipt of this notice.

Witness (if employee refuses to sign)

______

Name Date Time

Distribution of copies:Employee FileSupervisorDepartment Head

Human Resources

Source: Human Resources

December 2012