Counseling Interview Memorandum


(Used to clarify verbal agreements and possible behavior changes between a supervisor and an employee.)


November 21, 20__

TO: (Employee)

FROM: (Supervisor or Manager)


This is to summarize (and make a matter of record) our conference of the above date.

  1. During the conference, the following items were discussed.
    1. (Use the shortest possible description but be specific and complete. These may later become "charges".)
  2. During the conference, you stated the following:
    1. (This paragraph is optional. Use it only if the employee makes statements significant to the issue. Do not use it to provide the employee with a written alibi.)
  3. During the conference, I offered you the following assistance and guidance:
    1. (Be specific! If offering helpful control techniques, spell them out. Avoid generalizations.)
    2. (Include the names of publications given to the employee, opportunities to visit other locations to observe the work of others, and names of individuals who will assist the employee.)
  4. During the conference you were directed: (Use when necessary)

If you do not believe this is an accurate summary of our conference, please notify me in writing by * (date) so that we can clarify any misunderstanding. If I do not hear from you, I shall assume the above to be an accurate summary of our conference.

* Be sure to give at least three or four working days for response.