Team Member Counseling Record Form
Please complete all sections to document your counseling conversation. This form is designed for recording key details and action items from your discussion.
Team Member Name
*
First Name
Last Name
Counselor Name
*
First Name
Last Name
Date of Counseling Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Counseling Topic
*
Please Select
Performance Improvement
Attendance
Conduct/Behavior
Career Development
Other
Summary of Discussion
*
Action Items / Next Steps
*
Follow-Up Date (if needed)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Comments
Submit Counseling Record
Should be Empty: