Counseling/Coaching Write-up

Form No.:
Date:_________________________
Name :
Position :
Department/Branch:

Dear Mr. /Ms ____________________________________,

This is to record that you have been counseled/coached today ________________________regarding policy in
___________________________________. Please refer to the attached document.

After counseling/coaching session, the policy regarding _____________________________________ has been

explained to you. In the future, we expect you to carry out the correct procedures / behavior.

You committed that this will not happen again. If the similar incident occurs in the future, proper disciplinary action
will be duly applied.

_________________________________________________
Immediate Superior’s Printed Name and Signature

Conforme :

Signature of Employee over Printed Name

Note: This counseling/coaching session/s will be treated as highly confidential.