SAMPLE COUNSELING SESSION MEMORANDUM

(Used to confirm discussion related to conduct or performance matters)

DATE: xxxxxxxxxxxxx

TO: Employee

FROM: Supervisor

SUBJECT: Confirmation of Counseling Session

_____________________________________________________________

This is to summarize our counseling session of the above date.

During the session, the following items were discussed.

(Use the shortest possible description but be specific and complete.) Example:I reminded you of your responsibility to check your equipment prior to the start of each shift and report any problems to your immediate supervisor before leaving the yard or using the equipment. I also expressed concern over recent reports from your immediate supervisor of instances where you have stopped work in the middle of a job citing problems with equipment. Specifically, on several recent occasions, including February 8, 1999, you refused to continue work on a job due to problems with your equipment. When the condition of the equipment was brought to the attention of your immediate supervisor, he agreed the equipment was in poor condition and could present a safety problem. Your supervisor then had to make a trip back to the yard for a replacement before the work could continue, thus creating a significant delay in completion of the job. My concern is that you did not note the poor condition of the equipment until you were in the middle of a job.

During the session, you stated the following:

(This paragraph is optional. Use it only if the employee makes statements you feel are significant to the issue and warrant inclusion.) Example:You said that you were concerned about safety and did check your equipment before leaving the yard, but problems with specific pieces of equipment did not become apparent to you until you were using the equipment.

During the session, I offered you the following assistance and guidance:

(Be specific. If offering helpful control techniques, spell them out. Avoid generalizations. For example, you may want to cite work rules, policies or procedures given to the employee, the opportunity to visit an EAP counselor, training provided…) Example:

1. A daily check of your equipment before leaving and upon returning to the yard should give you a good picture of when to ask for a replacement. When in doubt, ask for a replacement upon returning to the yard, or before leaving the yard. If the old equipment can be repaired or is still usable, it can be put back into service at a later time.
2. Use the regular safety meetings to discuss equipment replacement issues with your immediate supervisor and your fellow crew members. This will give you a sense of how often others are replacing certain pieces of equipment, and what signs to look for that would indicate a piece of equipment needs to be replaced.

I recognized that instances will occur where equipment will experience a sudden failure or raise a sudden safety concern, and in those instances you should immediately discontinue use and report it to your supervisor. However, maintaining familiarity with the condition of the equipment assigned to you on a daily basis will decrease the instances where you need to stop a job due to equipment problems.

During the session you were directed to: (Use when necessary.)

Please be advised that if you do not improve in this area, the District may take disciplinary action in the future. If you do not believe this to be an accurate summary of our session, please notify me in writing by (date) so we can clarify any misunderstandings. (Be sure to give at least three or four working days for response.)

Cc: (Note: For supervisor's file only. Do not provide copies)