DATE:
PHONE:
FROM:
AUTHOR’S NAME, Author’s Title
Author’s Department
TO:
RECIPIENT NAME(S), Recipient Title(s)
Recipient’s Department(s)
SUBJECT:
MEMO OF CONCERN
The purpose of this memo is to summarize the Department’s continued concerns with [INSERT TOPIC]
§ Reiterate the importance of the policy/procedure, conduct or behavior that is causing concern, or how the
employee continued to fail to adequately carry out a directive, assignment or instruction.
§ Reiterate the impact of not following the policy/procedure. Example: “Failure to operate a County vehicle
in accordance with policy may result in damage to County equipment”.
§ Indicate when this instruction/expectation was previously discussed or had been previously trained or
counseled. Indicate dates/times of prior verbal counseling and date written documentation was issued to
the employee.
§ Provide a clear directive to the employee. Example: “You were previously instructed to operate a County
vehicle in safe and responsible manner in accordance with all applicable laws.”
§ Provide consequences an employee may face if he/she fails to follow the directive. Example: “Failure to
follow these directives will result in disciplinary action, up to and including dismissal.”
I acknowledge receipt of this Memo and understand that a copy will be placed in my personnel file.
_____________________________ _____________
Employee Date
cc: Department Contacts (e.g. Mary Doe, Administrative Manager)
Human Resources Officer (if appropriate)
Department File (if appropriate)
Official Personnel File (if appropriate)
Interoffice!Memo
Attachment #5
NOTE: Generally the employee should
have already been verbally counseled
and issued written documentation before
receiving a Memo of Concern.
