Employee Remedial Training Form

This form is to be completed when an employee has been notified about deficiencies or problems
in their work performance. It is to be reviewed with the employee and signed by the employee,
supervisor, training coordinator and where pertinent the Assistant Director and/or Director.

The following presenting problem(s) have been identified. The associated objectives and goals
were discussed and agreed upon by all parties involved.

Presenting Concern(s): ____________________________________________________

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Objectives & Goals: ______________________________________________________

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Employee Name (s): ______________________________________________________

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Tasks/Interventions [Assignments to Be Completed]: ___________________________

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Deadline Date(s) [When Due]: ______________________________________________

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Employee Signature:___________________________ Date: ___________________

Supervisor Signature:____________________________ Date: ________________

Training Coordinator Signature: ____________________________ Date: __________________