Lead communication to HR re: staff PERFORMANCE concern Form

* = Required Information

Lead communication to HR re: staff concern

This form is to be completed by the Lead Counselor to alert Human Resources of a performance concern related to their staff. HR and the PD will determine if points will be issued.

Name and Title of supervisor submitting this form *

Name of person with the performance concern
First Name *

Last Name *

Location *

Date of performance concern *

Time of day the performance issue occured *

In detail, please explain the infraction(s) that occured. Provide as many details as possible, including dates and why the person should have been aware that the infraction was contrary to policy or supervisor directives.