Corrective Action Form (PDF) Adobe Reader (PDF)

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Title: Microsoft Word - Corrective Action Form.doc
Author: lesliec

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Corrective Action Form


Job Title/Dept:


Level of Correction Action:
Verbal Warning/Counseling

Written Warning

Suspension w/out pay






Further Disciplinary Action that Could Result from Failure to Show Improvement:


Page 2

Corrective Action Form


Re-evaluation meeting scheduled for:
Signing this statement does not necessarily mean that I agree, it simply indicates acknowledgement that this document was
reviewed with me. I understand that acknowledging this discipline does not constitute a contract, and does not change my
employee at will status. The County reserves its right to skip progressive discipline steps and go directly to termination at its

Employee’s Signature:___________________________________________ Date: ___________________
Supervisor’s Signature: __________________________________________ Date: ___________________
A copy of this corrective action will be placed in your personnel file for reference.

Supervisor Instructions for Completing Corrective/Warning Action Form
When documenting corrective action it is helpful to use the following steps:
1. Facts: List only facts, not opinions. Give concrete examples, when possible, to document the incorrect behavior.
2. Objectives: What is the desired outcome? What do u expect You may want to cite a portion of the job description or a policy.
3. Solutions: How do you suggest that he/she improves their performance? Does the employee have any suggestions?
You may offer additional training review of procedures, etc.
4. Action: Tell the employee in writing that he/she is receiving a warning, suspension, etc., and set a date to review his/her progress
toward obtaining the goals set.
Please use additional forms if the employee has more than one area that needs improvement. The employee must sign the corrective action
Form to acknowledge receipt. If the employee refuses to sign write “REFUSED TO SIGN” and sign your name as a witness. The supervisor will
give a copy of the signed document to the employee and the original will be submitted to HR to be placed in the personnel file.

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