DA Form 4856 Monthly Counseling Example

PART II - BACKGROUND INFORMATION

Purpose of Counseling: (Leader states the reason for the counseling, e.g. Performance/Professional or Event-Oriented counseling, and includes the leader's facts and observations prior to the counseling.)

To:

o Discuss PVT Collier's duty performance for the month of December.
o Cover duty performance, personal issues, promotions, and upcoming events.

PART III - SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.

Key Points of Discussion:

Duty Performance: Your overall performance for the past month has been outstanding.

1. Areas you should sustain:
2. Areas you should improve:

Personal Issues: During the last month, we talked about your problem with the bank and your problem making your car payment on time. As a result...

Promotion Recommendation/Potential:
Current TIS: _____ months. Current TIG: _____ months.

1. Promotion to SGT in the primary zone requires _____ months TIS and _____ months TIG.
2. Promotion to SGT in the secondary zone requires _____ months TIS and _____ months TIG.
3. Currently you are eligible for promotion in the secondary zone.

Upcoming Events: Next month we're scheduled to attend the M-16 range. To prepare...

Tasks: None
In closing, based on your performance, I expect good things from you as I do with all Soldiers. We will accomplish all tasks together as a team. If you need assistance in any area, do not hesitate to ask for assistance. If you have any problems, inform me immediately.

My phone number is (123) 456-6791 ________ (Soldier's Initials)

OTHER INSTRUCTIONS
This form will be destroyed upon: reassignment (other than rehabilitative transfers), separation at ETS, or upon retirement. For separation requirements and notification of loss of benefits/consequences see local directives and AR 635-200.

DA FORM 4856, MAR 2006 EDITION OF JUN 99 IS OBSOLETE
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Plan of Action: (Outlines actions that the subordinate will do after the counseling session to reach the agreed upon goal(s). The actions must be specific enough to modify or maintain the subordinate's behavior and include a specified time line for implementation and assessment (Part IV below)

Schedule Financial counseling and make appointment with loan officer. Review range safety procedures. Follow instructions and follow up next month.

Session Closing: (The leader summarizes the key points of the session and checks if the subordinate understands the plan of action. The subordinate agrees/disagrees and provides remarks if appropriate.)

Individual counseled: I agree / disagree with the information above

Individual counseled remarks:

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Signature of Individual Counseled: _ _ _ _ _ _ _ _ _ _ _ _ Date: 25 Dec 2014

Leader Responsibilities: (Leader's responsibilities in implementing the plan of action)

Monitor Soldier progress on areas requiring improvement
Prepare Soldier for promotion board
Provide leadership and guidance as necessary

Signature of Counselor: _ _ _ _ _ _ _ _ _ _ _ _ _ Date: 25 Dec 2014

PART IV - ASSESSMENT OF THE PLAN OF ACTION

Assessment: (Did the plan of action achieve the desired results? This section is completed by both the leader and the individual counseled and provides useful information for follow-up counseling)

As discussed during November's counseling session, PVT Collier registered new dependent in DEERS and is ahead of schedule in training. He has worked out a payment schedule with the bank that will prevent future problems.

Counselor: _ _ _ _ _ _ _ _ _ _ _ _ _ Individual: _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _

Note: Both the counselor and the individual counseled should retain a record of the counseling.

REVERSE, DA FORM 4856, MAR 2006
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