Counseling Memo Format



To:            Employee Name, Job Title

From:            Supervisor Name, Job Title

Re: Counseling Memo for _________________________

This is to confirm the meeting that I had with you on _______________.  During this meeting, which was attended by ______________________, I expressed my concern about (describe the inappropriate behavior and the consequences of the employee’s actions)

During this meeting I told you that I expect you to ………

You indicated that… (describe employee’s response)

(If it is appropriate to refer the employee to the Employee Assistance Program, add: “I encourage you to contact the Employee Assistance Program for confidential assistance in resolving any personal problems that may be impacting your work performance and/or and/or behavior”.  However, please understand that it is your responsibility to ensure that you correct the concerns listed above). 

I will be giving you an evaluation within the next 30 days to let you know how you are doing in maintaining good performance and achieving these goals.  Please let me know if you have any questions regarding these instructions.

cc:   Personnel file

        Departmental Manager