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DRAFT (KEEP “DRAFT” UNTIL FINALIZED) XX (INSERT FORMAL OR FINAL) COUNSELING ACTION PLAN
XX To: (INSERT EMPLOYEE NAME) From: (INSERT SUPERVISOR OR MANAGER NAME)
XX (JOB TITLE)
XX (DATE OF HIRE)
XX (INSERT DATE OF COUNSELING MTG)
Problem
WORK PERFORMANCE: XX (Insert Specifics. Ex: Not Working, Sleeping, Neglect of Duty, Safety, Failure to Follow Directive, Cleanliness/Work Standards, Not
Meeting Deadlines, Poor Customer Service, Extending Breaks, etc.)
Even though you were previously XX (INSERT COACHED AND/OR FORMAL COUNSELED) on XX (INSERT DATE), your performance remains unsatisfactory.
(DELETE IF NO PREVIOUS COACHING OR FORMAL HAS OCCURRED)
Most recent incident(s):
1. On XX (INSERT DATE/TIME/LOCATION), XX (INSERT INCIDENT/EVENT/COMPLAINT INCLUDING WHAT, WHERE, WHEN, WHO)
2. XX (INSERT SECOND INCIDENT IF APPLICABLE)
During the fact finding meeting held on XX (INSERT DATE), you stated XX (INSERT INFORMATION PROVIDED BY EE DURING FACT FINDING IF APPLICABLE)
Impact:
XX (INSERT IMPACT OF PERFORMANCE PROBLEM TO DEPT/SHOP/AREA. EX: Your failure to perform your daily duties has a negative impact on customer
relations and places a burden on coworkers/sups/mgrs. Your poor performance portrays a negative image on the dept/shop/area and does not contribute to a
spirit of cooperation or willingness to support client’s needs. Being seen not working during work hours by your co-workers, clients/customers is
unacceptable. Incomplete assignments negatively affects our ability to be an efficient and responsive team)
Expectation
Follow University and Facilities Services policies and procedures, specifically but not limited to: (DELETE WHAT IS NOT APPLICABLE)
The Facilities Services Employee Handbook
Under Performance Standards it states in part:
The University's continuous effort to achieve excellence in its education, research, and community service activities requires high standards in the
individual performance of every employee.
FS HR 07/2015
SUPERVISOR/MANAGER SIGNATURE: ________________________________________
DATE: _________________________
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Under Attendance it states in part:
Each employee is expected to know and adhere to his/her schedule, including breaks…
Under Health & Safety it states in part:
Each employee is expected to promote safe work practices, to participate in occupational health assessment programs and to help maintain property and
equipment in a safe operating condition.
An employee must report all work-related injuries, illnesses and near miss incidents to their supervisor as soon as possible....An online accident report
(OARS) must be submitted within 24 hours after an incident that could have resulted in an accident, a work-related illness and/or near miss.
UW Employee Performance states in part:
Your ability to perform effectively in your job requires that you have and understand a complete and up-to-date job description for your position, and that
you understand the job performance requirements and standards that you are expected to meet.
UW Presidential Orders Executive Order No. 55 states in part:
….staff shall be directly responsible for their own safety, for the safety of students…and for the safety of their fellow employees.
As stated in your job description under “Class Series Concept”:
XX (INSERT APPROPRIATE WORDING FROM JOB DESCRIPTION; DELETE IF NONE)
XX (INSERT APPROPRIATE DEPT POLICY AND/OR ACCOUNTABILITY PROTOCOLS; DELETE IF NONE)
Follow the instructions and/or directions given to you by your chain of command.
During work hours you are expected to be at your work assignment and working. Adhere to your designated work schedule as follows:
Start: XX (INSERT TIME)
Break: XX (INSERT TIME)
Lunch: XX (INSERT TIME)
End: XX(INSERT TIME)
Complete all assignments and duties in a thorough, safe and timely manner.
FS HR 07/2015
SUPERVISOR/MANAGER SIGNATURE: ________________________________________
DATE: _________________________
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Your performance within the work environment must comply with Facilities Services and University’s policies and procedures.
Make sure you understand:
 The job duties you are expected to perform
 My expectations for your job performance
If for any reason you need to request changing your scheduled break and/or lunch time get approval from your supervisor first by calling:
XX (INSERT SUPERVISOR NAME & NUMBER)
XX (INSERT NAME & NUMBER OF BACK UP CONTACT AREA/OFFICE)
Failure to adhere to these expectations immediately may result in further corrective action, up to and including dismissal.
If you have questions regarding these expectations, please discuss with me immediately.
To assist you in improving your performance, you are required to attend XX. (INSERT TRAINING NAME/DATE/TIME/LOCATION; DELETE IF NOT SENDING) I will
sign you up for this class when it is offered next.
CareLink is available for all employees to discuss workplace and/or personal issues.
FS HR 07/2015
SUPERVISOR/MANAGER SIGNATURE: ________________________________________
DATE: _________________________