University of Houston-Victoria
Documentation of Oral Counseling

FORM A

Employee Name ___________________________________________Date_____________

Department _______________________________Job Title__________________________

SUPERVISOR'S STATEMENT

 

 

 

 

EMPLOYEE'S STATEMENT

 

 

 

 

ACTION TO BE TAKEN

 

 

 

 

________________________________	     _____________________________________ 
Supervisor Signature     		Date         	 			Employee Signature        Date