60 Niagara Street, 2nd Floor, Buffalo, NY 14202
Phone: (716) 268-8705 Fax: (716) 589-2290

EMPLOYEE COUNSELING FORM

Employee Name:
Date:	Coordinator:

Reason for Discipline:
Disciplinary Action:
By means of: In Person Skype Phone
Description of Issue(s):
Issue Resolution and Expected Results:
is aware that this is their final warning. Any subsequent issues/violations of policy may result in immediate termination.

Employee Name PRINT:
Employee signature: Reset Signature	Date:
Witness Name PRINT:
Witness signature: Reset Signature	Date:
Supervisor name PRINT:
Supervisor signature: Reset Signature	Date:

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