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Doc NO:
LR 7
Revision:
1
Next Revision: Jan 2026
Controlled by:
Authorised by:

Subject: Poor Work Performance Counselling

Employee number: ______________________________________
Name of Employee: __________________________________________
Job Title: ______________________________
Date and time of councelling: ___/___/2026_____:_____

Description of Standard, Procedure or Expected work Performance not met:

1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________

Standard, Procedure or Expected work Performance:

1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________

Agreement: Training, Adjustment, Commitment and Time frame:

1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________
Employee: ______________________________________
 Date: __________________________________________
Councellor: ______________________________
 Date: __________________________________________
Date and time of follow up: ___/___/2026_____:_____
Name of Employee: ______________________________________
Job Title: __________________________________________
Date and time of councelling: ___/___/2026_____:_____

Description of Standard, Procedure or Expected work Performance met:

1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________

Description of Standard, Procedure or Expected work Performance not met:

1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________

Action to be taken:

1________________________________________________________________________________
__________________________________________________________________________________
2:________________________________________________________________________________
__________________________________________________________________________________