SAMPLE FORMAT – WRITTEN CORRECTIVE ACTION
DATE:
TO:
FROM:
SUBJECT: Written Corrective Action [INSERT REASON(S)]
This is to advise you that you are being issued an official written reprimand for the
reason(s) stated:
[INSERT DETAILED DESCRIPTION USING FOSA AND INCLUDING ALL
APPLICABLE DATES]
F
Facts to define the problem
O
Objectives to explain to the employee how to resolve the problem
S
Solutions that can help the employee reach the objectives
A
Actions you will take if the problem is not corrected
+
Plus your overall efforts to help the employee succeed
It is regrettable that this step is necessary, but your inappropriate behavior cannot and
will not be condoned or tolerated. Repeated instances of this type of behavior may
result in more severe discipline up to and including termination.
Signature of Supervisor
Date
Signature of Employee Acknowledging Receipt
Date
Copy to: [INSERT NAMES AS APPLICABLE]
HR Personnel File
Note: Copy is submitted to human resources for inclusion in personnel file.