| PART II - BACKGROUND INFORMATION | |
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Purpose of Counseling You have approved, scheduled leave from _______ to _________. It is my responsibility as your supervisor to brief you on your responsibilities while on leave and advise you of any safety or procedural concerns. |
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| PART III - SUMMARY OF COUNSELING Complete this section during or immediately subsequent to counseling. |
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Key Points of Discussion: This counseling addresses the fact that you are going on ordinary Leave from _______ to _______. Your destination is ______ and you will be traveling by POV. Every year the Army loses many of its most productive members due to auto accidents while on leave. The top three reasons for auto accidents are: speed, fatigue, and drinking and driving. Speed. Watch your speed. Be aware of conditions and adjust your speed to compensate for traffic and weather conditions. Fatigue. Many Soldiers begin their leave after getting off work. This is not a good idea because they have been up for 16 hours and are approaching the time that their body expects to be be going to sleep. This results in fatigue and slower reflexes and reaction time and dramatically increases the chances that a person will fall asleep at the wheel. Don't become a statistic. Don't start travel until you are well-rested. While driving, you should stop every 2 hours to stretch and maintain alertness. Limit driving to 8 hours a day. Don't drink and drive. If you do drink, make sure you have a designated driver or an alternate means of transportation available. Map out your route before you go and have proper emergency equipment on hand (spare tire, jumper cables, flares, etc). Be aware of speed traps and the difficulties that being pulled over in a strange town can present. Carry a fully-charged cellphone and emergency contact numbers. Plan ahead and ensure that you allow enough time to return on time. AUTHORITY FOR LEAVE: You are required to keep your approved leave form (DA Form 31, Request And Authority For Leave), your LES, and this counseling statement with you at all times while on leave. This is your authorization to be on leave. ITINERARY: You are required to provide your travel itinerary and emergency contact phone numbers to your supervisor. CHANGES: If your leave dates change, you must notify the chain-of-command immediately. DEPARTURE/RETURN: You must begin and end leave in the local area. When reporting back from leave, you must sign in to the unit no later than 2400 on the last day of leave (Block 10b). It is your responsibility to ensure that you return from leave on time. Failure to do so may result in punitive or administrative action. TRAVEL EXPENSES: You are responsible for all your travel expenses. You must ensure that you have enough money to cover any additional expenses you may incur for an alternate travel mode in the event your scheduled transportation is delayed or cancelled. If you do not have adequate funds for an alternate means of travel, contact the Army Personnel Assistance Point (PAP) at 404-569-5740 (Atlanta) or 972-574-0388/(800) 770-5580 (Dallas). LEAVE EXTENSIONS: Extensions of more than 7 days can only be approved by the Commander. ADVANCE LEAVE: Advance leave may be approved by the commander for up to, but not more than, 7 days. MEDICAL TREATMENT: a. If you require medical treatment while on leave, report to the nearest military medical facility. In the absence of such a facility, report to a uniformed services treatment facility or Veteran's Administration facility if possible. If you encounter any problems while on leave or if your scheduled return from leave will be delayed, contact me at __________ or notify the Commander or First Sergeant at ________ as soon as you become aware of the delay. IMPORTANT PHONE NUMBERS: American Red Cross : 877-272-7238 Army Emergency Relief Fund (AER): 866-878-6378 Personnel Assistance Point (PAP): 404-569-5740 (Atlanta) or 972-574-0388/(800) 770-5580 (Dallas) |
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OTHER INSTRUCTIONS |
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DA FORM 4856-E, JUN 99 EDITION OF JUN 85 IS OBSOLETE |
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Plan of Action: - Keep your leave form (DA Form 31) and LES with you at all times - Plan ahead and maintain adequate funds for return travel - Leave an itinerary of planned travel - Contact the unit if your leave dates change or to request a leave extension - Inform the unit if you need medical attention while on leave - Think safety! We need you back! |
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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) I know that you're on leave and don't want to think about the Army while you're gone but try to keep safety in mind. Safety in driving, safety in your personal conduct. Be vigilant and have a good time. Individual counseled: I agree / disagree with the information above Individual counseled remarks: Signature of Individual Counseled: _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ |
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Leader Responsibilities: (Leader's responsibilities in implementing the plan of action) I will ensure that you are aware of your responsibilities while on official leave. In addition, if there are any changes to the schedule that affect you on your return, I will inform you as soon as possible. Signature of Counselor: _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ |
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| 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: _ _ _ _ _ _ _ _ _ _ _ |
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| Note: Both the counselor and the individual counseled should retain a record of the counseling. |
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DA FORM 4856-E (Reverse) |
