* = Required Information
Record of Reliability Counsel
To be completed by HR
Type of notice given
Please select
1st Notice (Verbal)
2nd Notice (Written)
3rd Notice (Final)
First Name
*
Last Name
*
Date contact made with the employee regarding the reliability infraction
Date of reliability infraction
Location of reliability infraction
Explain in detail, the reliability policy infraction
Expectations given to the employee for future performance
Employee Response
Was the employee retrained in the violated policy or protocol?
Yes
No
Name of HR staff completing this form
First Name
Last Name
Submit