Peter Bishop (2346)

Occur. #

6

Title: Operator

Location: Nicollet

Next Shift: 9 FEB 8PM - 4AM

Manager: Tony Stark

Apply FMLA

Eligibility Date:

Has available FMLA hours?
  FMLA Used: hhh
  Remaining: hhh
  Undesignated: hh : mm
Available FMLA Certificates (click to apply)

FMLA History

Absence Management

Return to Absence Hub
Absence: mm/dd/yyyy - mm/dd/yyyy FMLA 020
mm/dd/yyyy - mm/dd/yyyy [insert Pay Code] Hours: 00:00
Source comments go here.
mm/dd/yyyy - mm/dd/yyyy [insert Pay Code] Hours: 00:00
Source comments go here.

Chargeable Occurrence (Yes): 5

Chargeable Occurrence:

Reason for changing chargeability:

Change Notes: (required)

Sign-Off Milestone

Signature(s) needed from:

  • [insert employee name/badge #]
  • [insert manager name]

Counseling Milestone

Reason for Counseling: Absenteeism Record

Chargeable Absence Dates:

# DATE(S) PAY CODE
6 07/06/2016 - 07/07/2016 1024 - Sick
5 07/01/2016 1024 - Sick
4 06/28/2016 2029 - Request Off Chargeable
3 06/27/2016 2006 - No Show
2 06/20/2016 2005 - Late for Work
1 06/13/2016 2005 - Late for Work

* Describe events or behavior leading to this counseling:
[Login Name] on [date/time]: [Populate submitted comments here.]

Action Plan:
* 1. What are the consequences if performance does not improve?
[Login Name] on [date/time]: [Populate submitted Performance Improvement Plan here.]

* 2. Describe the actions employee will take to improve performance.
[Login Name] on [date/time]: [Populate submitted Performance Improvement Plan here.]

Employee Action:

I received information regarding the Employee Assistance Program (EAP).

My signature indicates my agreement that this is an accurate summary of the counseling discussion. I understand this is not a disciplinary action, but will be entered into my personnel record. If my attendance does not improve, progressive discipline may be administered.

[insert employee name/badge #] signed.

[insert manager name/badge #] signed.

[insert witness name/badge #] signed as witness.

[insert first name] [insert last name], [insert description] signed as witness.

Additional Persons Present
[First Name] [Last Name] [(description)]

Notes
(These notes will not print on the employee record.)
[Login Name] on [date/time]: [Populate submitted notes here.]

Documents
[Login Name] on [date/time]: [Populate submitted documents here.]

#unique doc id