Corrective Action Form

Please read the below slides before you complete the form. If you have any questions, please reach out to your manager directly or contact LaQuanda McCoullum, Manager of Employee Relations.
Name of Team Member Receiving this Corrective Action Form:

First NameLast Name
Job Title of the Team Member Receiving this Corrective Action Form:
Please select the STATE in which the team member receiving this Corrective Action works:
Please select the DISTRICT in which the team member receiving this Corrective Action works: (If District is not listed, please select Other)
Please select the SITE LOCATION in which the team member receiving this Corrective Action works: (If Site is not listed, please select Other)
Who is completing this form? (Enter the name of the MANAGER of the Team Member receiving this Corrective Action)

First NameLast Name
What is the Job Title of the person completing this form? (Enter the job title of the MANAGER of the Team Member Receiving this Corrective Action Form):
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Choose One
This issue is related to:
Please select the reason for this Corrective Action:
Select which Core Value is not being exhibited (choose all that apply):
Date Issue/Incident Occurred:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Statement of the Problem/Impact to Organization or People: (Please include the date(s) of the issue or concern and provide specific details about the incident and the reasoning behind the write-up being issued.)
PRIOR DISCUSSIONS AND/OR WARNINGS SECTION
Date of prior discussions held with team member. If no discussions have been previously held, please type N/A
Description of Prior Discussion, if Applicable. Include Specifics, such as date (s) of discussion, who was present for discussion, what was discussed, actions that resulted from the discussion and follow up notes. If no previous discussion has been held, please type N/A.
Please attach any supporting documentation regarding this team member and this corrective action here. If no documentation, please proceed to the next field.

Cancelof
Statement of Company Policy on Subject
Date to Accomplish Improvement

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recommendations and Date for Improvements to be Made and/or Notes for Follow Up Meeting If Applicable.
Consequences of Failure to Improve Performance or Correct Behavior
This Corrective Action is effective on today's date. If, at any time after this date, you fail to meet expectations further corrective action may be escalated up to and including termination.
Manager Signature (ex - Area Manager/District Manager, etc.)
Manager Email Address
For example, jsmith@alphabest.org
APPROVALS SECTION
What is the name of your supervisor? [Enter the name of the MANAGER OF THE PERSON WHO IS COMPLETING this Corrective Action Form (ex - Regional Manager, Director, etc.)]

First NameLast Name
What is the job title of your supervisor? (Enter the job title of the MANAGER OF THE PERSON WHO IS COMPLETING this Corrective Action Form:)
What is the email address of your supervisor? (Enter the email address of the MANAGER OF THE PERSON WHO IS COMPLETING this Corrective Action Form)
For example - jsmith@alphabest.org
Signature of the Manager of the Person Completing this CAF (AFTER REVIEWING DOCUMENT)
Human Resource Approver Name (Please type LaQuanda McCoullum or Crystal Walker in these fields.)

First NameLast Name
Human Resources Approver Email Address (Please type lmccoullum@alphabest.org or cwalker@alphabest.org in this field. )
Please type - cwalker@alphabest.org
Human Resources Signature of Approval (AFTER REVIEWING DOCUMENT)
Team Member Email Address
TEAM MEMBER ACKNOWLEDGEMENT SECTION
Team Member Signature (TO BE SIGNED AFTER DISCUSSION HAS TAKEN PLACE)
Team Member Comments (If no comments, please write N/A.)
By signing this form, I am indicating that the content has been discussed and reviewed with me.
If you choose not to sign, please initial here.
Initials
humanresources@alphabest.org
example@example.com
HR NOTES (If Needed)
Should be Empty:

Please read the below slides before you complete the form. If you have any questions, please reach out to your manager directly or contact LaQuanda McCoullum, Manager of Employee Relations.

PRIOR DISCUSSIONS AND/OR WARNINGS SECTION

Consequences of Failure to Improve Performance or Correct Behavior

APPROVALS SECTION

TEAM MEMBER ACKNOWLEDGEMENT SECTION