Lead Communication to HR re: Staff Reliability Form

* = Required Information

Lead Communication to HR re: Staff Reliability

To be completed by the Lead Counselor of Program Director.
Please complete a separate form for each staff reliability occurence.

Name and Title of person submitting form *

Employee Name with Reliability Issue

First Name *

Last Name *

Date of Reliability Issue *

Site/Location Name *

Select one of the following reliability concerns (select all that apply, if any)

If the employee found coverage for their missed shift, was the coverage approved by the Supervisor?

The Supervisor DID approve the coverage

The Supervisor DID NOT approve the coverage

Not applicable

Select one of the following reliability concerns (select all that apply, if any)

Please include any additional information below. This can include conversations, camera checks, punch-in/punch-out, and any other supporting evidence.