PERFORMANCE CORRECTION NOTICE

DISCIPLINARY LEVEL

Verbal Correction—(To memorialize the conversation.)

Written Warning—(State nature of offense, method of correction, and action to be taken if offense is repeated.)

Investigatory Leave—(Include length of time and nature of review.)

Final Written Warning

Without decision-making leave

With decision-making leave (Attach memo of instructions.)

With unpaid suspension

SUBJECT:Excessive absenteeism, failure to provide appropriate medical documentation

Policy/Procedure Violation

Performance Transgression

Behavior/Conduct Infraction

Absenteeism/Tardiness

PRIOR NOTIFICATIONS

Incident Description and Supporting Details: Include the following information: Time, Place, Date of Occurrence, and Persons Present as well as Organizational Impact.

Farid,

Maintenance of good attendance is a condition of employment. In order to minimize hardships that may result from illness or injury, our company provides paid sick time benefits to employees for use when their own or a family member’s illness or injury prevents them from working. However, periodic sick leave taken on a repeated basis may be viewed as abuse of the system. It is your responsibility to establish legitimate illness or injury in order to receive sick leave pay pursuant to our sick leave policy.

On October 3, you received a verbal warning for five incidents of unscheduled, unauthorized absence (meaning an absence not protected by law or not approved by your supervisor) on the following dates:

August 4, 2017

August 30, 2017

September 15, 2017

September 25, 2017

October 3, 2017

On October 8, you reached your one-year anniversary and became eligible for FMLA (Family and Medical Leave). On October 9, you brought in a doctor’s note authorizing one to four days off per month as an “intermittent leave,” which was granted to you.

In October, you took four days off, which were approved under your leave, and then took off the following two days, even though you had no sick leave left in your bank:

October 25, 2017

October 30, 2017

You would normally have received a written warning for this fifth and sixth incident of unauthorized leave, but you then informed me that you would need an FMLA “block leave,” stating that your health situation warranted more time off from work. You stated that you would have your doctor amend the current FMLA instructions to move you from an intermittent to a block leave.

In November, you took four days off, which were approved under your original doctor’s instructions. However, you then took off the following two days, even though you had no sick leave left in your bank:

November 21, 2017

November 30, 2017

This would have normally resulted in a final written warning for nine incidents of unauthorized absence. However, you assured me that you would have a doctor’s note authorizing a block FMLA leave within three days.

In December, you took off four days in accordance with your intermittent FMLA leave. You then took off another day on the following date, even though you had no sick leave left in your bank:

December 17, 2017

Normally, this tenth incident would have resulted in your termination.

It has now been almost two months since you stated that you would provide the appropriate medical certification authorizing a block FMLA leave. To date, you have not provided this to us. As a result of your lack of follow-up, this document will serve as a written warning for failure to provide the appropriate medical documentation required under FMLA and to avoid corrective action under our company’s disciplinary policy.

In addition, this recent tenth incident warrants an additional written warning for excessive, unauthorized absence.

PERFORMANCE IMPROVEMENT PLAN

1. Measurable/Tangible Improvement Goals: Farid, I expect you to immediately improve your attendance to meet company minimum standards. I also expect you to remain true to your word and hold yourself accountable for obtaining the appropriate medical documentation necessary to justify your absences, pursuant to the FMLA and our policy.

2. Training or Special Direction to Be Provided: A copy of our attendance policy is attached. In addition, we are providing you with another FMLA application to provide to your doctor for the block leave, if you still require it. Please note that you have fifteen calendar days from now to submit the necessary medical certification.

3. Interim Performance Evaluation Necessary? No

4. Our Employee Assistance Program (EAP) provider, Prime Behavioral Health Group, can be confidentially reached to assist you at (800) 555-5555. This is strictly voluntary. A booklet regarding the EAP’s services is available from Human Resources.

5. In addition, I recognize that you may have certain ideas to improve your performance. Therefore, I encourage you to provide your own Personal Improvement Plan Input and Suggestions:

(Attach additional sheets if needed.)

OUTCOMES AND CONSEQUENCES

Positive: I will remain available to help you and discuss areas where you require additional support. If you meet your performance goals, no further disciplinary action will be taken regarding this issue. Demonstrating proper follow-through and commitment to cooperate with the company by providing the necessary medical documentation will also help our department meet its workforce planning and production scheduling goals.

Negative: You are now being placed on notice that according to company policy, if you reach a twelfth incident (the current ten plus two new incidents) of unauthorized absence (meaning an absence not protected by law or approved by your supervisor) in the rolling calendar year, you will be placed on a final written warning. A thirteenth incident of unauthorized absence in the rolling calendar year will result in termination.

In addition, your current intermittent FMLA leave provides for one to four days off per month to attend to your special needs on an intermittent basis. Unless additional time off is warranted by an updated medical certification, we will honor the current medical instructions. If you take additional, unauthorized time off, you may be subject to further disciplinary action up to and including termination. A copy of this document will be placed in your personnel file.

Scheduled Review Date: Fifteen days (January 12, 2018)

EMPLOYEE COMMENTS AND/OR REBUTTAL

EMPLOYEE ACKNOWLEDGMENT GOES HERE