Counseling Form

The Employee Counseling Form can help guide and document an employee counseling session. An employee counseling session is an opportunity for a supervisor to meet with an employee and discuss some aspect of the employee’s performance. It is not a form of punishment in itself, but rather a way to improve performance. The session may cover a particular thing that the employee has done or experienced, a task that the employee has completed or failed to complete, a tendency or habit of the employee, or the employee’s overall work for the company. Regardless of the purpose of the session, relying on a pre-prepared form can help both the supervisor and the employee get more out of the counseling by making it clear what information needs to be discussed and recorded. Using the form and preserving can help the company demonstrate that it took appropriate measures should problems develop down the line.

Complete this section during or immediately subsequent to counseling. OTHER INSTRUCTIONS. This form will be destroyed upon: reassignment (other than rehabilitative transfers), separation at ETS, or upon retirement. For separation requirements and notification of loss of benefits/consequences see local directives and AR 635-200. Counseling can come in various forms like employee communication counselling, for example. Counseling is one of the many beneficial resources under the mental health aspect that an individual can attain. The type of counseling to take should should be in line with the type of problem one has. Telemedicine or technology assisted counseling (TAC) consent, policies, & agreement. Must be completed for ALL clients wishing to use technology assisted counseling. Please note that this document must be signed before counseling. Telemedicine or Technology Assisted Counseling (TAC) Form (Signature).

Counseling form pdf

The supervisor should give the employee notice ahead of time to find a convenient time for the session, and arrange so that it may be conducted in private and without interruption. Particularly if the reason for the session is an incident that the employee was involved in or a problem with his or her performance, the supervisor should do the following:

  • gather necessary documentation associated with the incident or problem;
  • formulate a clear explanation of how the employee’s conduct does not meet expectations; and
  • state how this shortcoming is harmful to the overall work of the company.

This should consider tools, policy communications or training the employee has received that will provide evidence or identify gaps that could have caused the problem. Has the employee been properly instructed? Or is the problem rooted in imperfect communication from management?

The supervisor should let the employee know the reason the counseling session is being called, but should emphasize that it is not a disciplinary proceeding, although failure to correct the issue discussed may eventually lead to discipline. At some point before the session begins, the employer should explain that it is being documented. What to do with the form when it is completed should also be decided by the supervisor beforehand, and explained to the employee. Some advocate a three-step approach. In the first step, the document remains with the supervisor who conducted the session. In the second, if the first session did not address what the employer felt was needed, a new counseling form may be created and passed on to the company’s human resources department. In the third step, if issues still remain, an additional form may be filled out that may outline particular consequences for failure to improve, and the form may be added to the employee’s personnel file. No matter what stage of discussion the counseling form will document, the employer should be upfront with the employee.

As seen in the sample form, a counseling form should include:

  • The first and last name of the employee receiving counseling along with the date of counseling.
  • The issue being addressed. Common examples include unprofessional office behavior, lack of productivity or quality work, attendance, not following dress code, workplace safety violations, and harassment. Be prepared to explain not just the issue, but how it specifically harms the company’s performance
  • Relevant policies or procedures shared with the individual at time of hire or after.
  • The date of the incident(s) in question, details of the incident and names of witnesses if applicable
  • If there have been previous counseling sessions about this issue, the dates of those sessions and what, if anything, was agreed to or decided as a result of them
  • The suggested action the employer is requesting the employee to take, and how quickly the employee should begin them
  • Any employee comments made during discussion, including disagreements
  • The effective date of when the new behavior is expected, and a description of how to verify whether the employee has successfully done so
  • The signature of the employee acknowledging the issue and agreeing to remediate the behavior
  • Future actions an employer may take in response to the employee not correcting the behavior as requested

1. Identify the problem

The employer should detail out the exact problem that needs to be addressed. This may require further investigation into tools, policy communications or trainings the employee has received that will provide evidence or identify gaps that could have caused the problem.

2. Prepare employee for counseling

The employer should setup a meeting with the employee regarding the counseling, what is expected and what will be occurring during the session.

3. Admit employee into counseling sessions

Employer should allow employee into counseling session and engage the employee in open two-way dialogue.

Adopting a robust employee counseling program is associated with the following benefits:

  • Higher staff retention, which leads to reduced operating costs and affordability
  • Reduced absenteeism and sick time being
  • Improving company performance by removing barriers and identifying shortcomings among both management and employees
  • Provides the business opportunity to analyze an individual’s true potential. It will provide the employer with an opportunity to create a plan for the individual, direct action and coach effectively
  • Provides the business opportunity to increase the morale and confidence of an employee
  • Encourages the employee(s) to speak up regarding potential issues, particularly that supervisors may not be aware of, and increase accountability in the company

Generally, the first person to conduct an employee counseling session should be the employee’s department supervisor. However, if the session has progressed to the point that the completed form will be given to human resources, it may be advisable to include someone from HR as well. Alternatively, if the employer has reason to suspect that there may be mental health or substance abuse issues associated with the employee, it may be advisable to suggest a separate counseling session with a professional trained to address these issues.

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The Counseling Center has provided several frequently used forms for your convenience. Please see the links at left for an explanation of each form’s use, and a link to download the form.

Release of Information

The Counseling Center does not disclose any information about a client without his/her written permission. (Please see our Confidentiality Policy.) If you would like someone to be able to communicate with the Counseling Center about your treatment, you must fill out a PDF Document: Release of Information. You may come in to the Counseling Center and fill one out or you may print it from this website, fill it out at home and bring it to the Counseling Center, or fax the completed form to us at 410-516-4286.

Counseling Forms Online

Medical Leave of Absence

Counseling Form Army

For more information on Medical Leave of Absence and reinstatement, please visit the Office of the Dean of Student Life’s Medical Leave of Absence page.