Accountability Form
Date
*
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Month
-
Day
Year
Date Picker Icon
Employee Name
*
First Name
Last Name
Employee Email
List email only if they want an email copy
Job Title/ Department
*
Access Ambassador
Accounting
Ambulance- AMT
CSA/Dispatch
DGM
Driver/Chauffeur
Human Resource
Mechanic
Mobility- AMT
Shift
Day Shift
Mid Shift
Night Shift
Accountability Action
Type of Warning
Coaching Session
Verbal Warning
Written Warning
Supervisor Final Report
Supervisor Final Report with Separation of an Employee
Other
Type of Offense:
Absenteeism
Rudeness to Customers/Coworkers
Substandard Work
Tardiness/Leaving Early
Violation of Company Policy
Violation of Safety Rules
Violation of Company Core Values
Other
Details
Description of Infraction:
List behavior and reference policy
List Company Policies/ Guiding Principles that apply to the infraction:
Site all policy material and page number if applicable
Expected Improvement & Plan:
List what the expected behavior and Action plan and resources for improvement
Consequences of Further Infractions:
May lead up to further disciplinary action up to termination
Employee comments
Contact was made with this employee via
Email
In Person
Phone Call
Text
Employee Not Contacted Yet
Date conversation with employee took place
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Month
-
Day
Year
Date
Time conversation with employee took place
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
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Acknowledgement of Receipt of Employee Accountability Form
By signing this form, you confirm that you and your manager have discussed and understand the accountability action, and the plan for improvement. Signingthis form does not necessarily indicate that you agree with this Employee AccountabilityForm. Employee Signature
Manager Signature
Manager Name
First Name
Last Name
Manager Email
add manager email if this form will need to be edited
Witness Signature
Witness Name
First Name
Last Name
Notify HR
enter email address of HR director
Submit
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