U-C 3 CEA Employee Counseling Form Supervisor's informationSupervisor name:*Supervisor Email* Block 1 - Employee & Jobsite Data Verbal Only Employee Name*Employee Badge Number*Date of Event* Time of Event* : HH MM AM PM Scheduled Site #*Job Site Name*Scheduled Shift Time*Block 2 - Type of BehaviorEmployee demonstrated the following inappropriate behavior:* 01 - Abandoned job aite / left work 02 - Insubordination 03 - Sleeping on the Job 04 - Late for shift 05 - Failed to report for scheduled assignment 06 - Falsification of document / dishonesty 07 - Poor performance / improper conduct 08 - Violation of company / client rules or policies 09 - Illness without (4) hour notice of shift 10 - Out of company uniform / poor appearance or hygiene 11 - Negligent destruction of company / client property 12 - Other Block 3 - Description of CircumstancesDescribe the employee's behavior and circumstances under which the behavior was observed. Included dates, times, locations, witnesses, etc.Supervisor's description:*Block 4 - Desired FutureDescribe the behavior desired for the future, if appropriate.Supervisor's recommendation:Block 5 - Counselor's Recommendations & Follow-upRemember: Recognize / Reward Exceptional Behavior. Redirect and retrain whenever possible, if behavior is inappropriate. Suspend only as a last resort. Follow-up is REQUIRED where the demonstrated behavior is inappropriate. Typically follow-up is to be scheduled for 30, 60 & 90 days after the incident behavior does not repeat. Follow-up is not needed for call-offs/exceptional performance.Counselor's recommendation:Captcha
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