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:Document falsification

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.

Maryanne,

You were given a written warning on October 14, 2017, for documenting on a donor chart that venipuncture sites were checked at 1300 and 1315. You were out of the unit at the actual time that the charting was to have taken place.

Today, you are being given a final written warning for repeating the same offense on June 14. I entered the whole blood donor room at 1500 and was told by a floating technician who had just begun working on one of your donors that you had documented that your donor was checked at 1505. This was impossible since 1505 was still five minutes in the future.

When I asked you about this, you first stated that you must have made a mistake in the time. You then admitted that you “knew the patient would be all right,” so you left the work site. This repeat transgression violates our institution’s standards of performance and conduct.

PERFORMANCE IMPROVEMENT PLAN

1. Measurable/Tangible Improvement Goals: Maryanne, I expect you to accurately and truthfully reflect patient status in records at all times. There are to be no further exceptions—even for cases that seem routine. I expect you to make a commitment to me and the institution that you will never again engage in behavior that compromises patient safety or activities that falsify company documentation.

2. Training or Special Direction to Be Provided: I am providing you with a copy of departmental policies and procedures. Please reread this manual immediately.

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.

Negative: This repeated offense has jeopardized your job and warranted a special probation with more stringent requirements. You are now being placed on notice that if you ever again falsify company documents, you will be immediately dismissed. If you again compromise patient safety, disciplinary action up to and including termination will occur. No other chances will be given. A copy of this document will be placed in your personnel file.

Scheduled Review Date: None

EMPLOYEE COMMENTS AND/OR REBUTTAL

EMPLOYEE ACKNOWLEDGMENT GOES HERE

Note: Since this is a final written warning, add this sentence to the Employee Acknowledgment: “Furthermore, I understand that this is my last chance. If I fail to meet the terms and conditions outlined in this agreement, I will voluntarily resign or be discharged for cause.”