PART II - BACKGROUND INFORMATION |
Purpose of Counseling:
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PART III - SUMMARY OF COUNSELING Complete this section during or immediately subsequent to counseling. |
Key Points of Discussion:
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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-E |
Plan of Action:
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Session Closing: (The leader summarizes the key points of the session and checks to ensure the subordinate understands the plan of action. The subordinate agrees/disagrees and provides remarks if appropriate)
Signature of Individual Counseled: _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ |
Leader Responsibilities: (Leader's responsibilities in implementing the plan of action)
Signature of Counselor: _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ |
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)
Counselor: _ _ _ _ _ _ _ _ _ _ _ _ Individual Counseled: _ _ _ _ _ _ _ _ _ _ _ _ Date of Assessment: _ _ _ _ _ _ |
Note: Both the counselor and the individual counseled should retain a record of the counseling. |
DA FORM 4856-E (Reverse) |