Sample Memorandum Human Service

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					TO:             Employee's Name

FROM:           Evaluating Supervisor's Name

CC:             Reviewing Manager's Name, Reviewing Manager
                Name of Director of Human Resources, Director of Human Resources
                Name of Director of Legal Services, Director of Legal Services
                Name of Deputy Commissioner, Deputy Commissioner
                Name of Commissioner's Designee for Review of Adverse Action,
                Commissioner’s Designee for the Review of Adverse Action
                Personnel Record

DATE:           Date

SUBJECT:        Decision Making Leave

                                 -------------------------------------

This memo is to confirm our discussion on date of discussion about describe performance
problem(s).

This problem or Your overall performance was previously discussed with you informally on date(s)
of previous informal discussions. You received a Reminder 1, the first step of our formal
discipline procedure, on date of Reminder 1. You received a Reminder 2, the second step of our
formal discipline procedure, on date of Reminder 2. At that time or Each time we discussed what
was expected of you and you agreed to correct the problem. Since then, describe continuing
problem.

Because this continued poor performance or problem or violation has a major effect on safety or
our business or your fellow workers, I placed you on Decision Making Leave on date of decision
making leave.

During our discussion, I advised you that the Decision Making Leave was a disciplinary suspension
from work and the final step of our discipline procedure. I also told you that while you would be
paid for the day you were on Decision Making Leave, you were required to use that day to make a
final decision - either to solve the immediate problem and commit to maintaining fully acceptable
performance in every area of your job, or to resign and find more suitable employment elsewhere.

When you returned from the Decision Making Leave day, you told me that you had decided that
you wanted to continue your employment with us. You agreed that you would solve the immediate
problem and maintain fully acceptable performance.

As I advised you during our meeting, you must immediately correct this situation. In addition, you
must maintain fully acceptable performance in every area of your job, whether related to this issue
or not, since any further problems that require disciplinary action will result in your termination.
You may request a review of my action by contacting the Commissioner’s Designee for Review of
Adverse Action, within three (3) business days of the receipt of this memorandum. Name of
Commissioner's Designee for Review of Adverse Action may be reached at phone number of
Commissioner's Designee or you may request a review in writing by sending your response to this
action to address of Commissioner's Designee. Please note that your decision to request a review
of this action does not affect your commitment to me today to solve the immediate problem and to
maintain fully acceptable performance in every area of your job.




                                                       Evaluating Supervisor's Name
                                                       Evaluating Supervisor's Title



Employee's acknowledgment of receipt:


________________________________ / ________________
Employee's Name                       Date

				
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posted:8/5/2011
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Description: Sample Memorandum Human Service document sample