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Documentation of Verbal Counseling to Worker for Safety Violation




To: Worker’s Name
From: Supervisor
Subject: Documentation of Verbal Counseling for Not Following Safety Rules

Dear First Name:

This memo is a written record of the events that took place on [date]. At approximately [time], you were seen [describe violation(s)]. At [time], I met with you to provide verbal counselling to explain what you did wrong and why it constitutes a danger and violation of Company safety rules. I asked for your response and you explained [briefly summarize worker’s explanation]. We agreed that going forward, you would correct the problem and follow safety rules, specifically [summarize specific agreed to corrective actions].

As I explained, verbal counseling is a first step under the Company’s progressive discipline policy. This memo of counseling will be placed in your personnel file but will be removed after [time], provided that you make good on your promise to work safely and follow safety rules. However, I also made it clear that further problems may result in more severe discipline up to and including termination in accordance with the progressive discipline policy.

[First name,] I hope you’ll accept this counseling in the positive spirit in which it’s intended. We all make mistakes. I have every confidence that you will use this incident as a learning experience and not make the same mistake in the future. I also want to remind you that I’m here to help you improve and become and that you can come to me any time with questions.


Supervisor signature: ___________________________________________   Date: __________________

I have read and understood this memo:
Worker signature _______________________________________________ Date: __________________

CC:  OHS/HR Manager Name