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Doc NO:
LR 3
Revision:
1
Next Revision: Jan 2026
Controlled by:
Authorised by:

Subject: Counselling Form

Employee no: ___________
Employee name: __________________________________
Job Title: _______________
Date: ___/___/2026
DATE AND TIME OF COUNSELLING INTERVIEW: ___/___/2026
Description of Offence, Standard, Procedure or Expected work Performance not met:
1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________
Standard, Procedure or Expected work Performance:
1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________
Agreement
1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________
Follow-up date: ___/___/2026
Employee's signature: ____________________
Counsellor Signature: ____________________
Date: ___/___/2026
Date: ___/___/2026