ARIZONA STATE PERSONNEL SYSTEM
ADOA DISCIPLINE AND DISMISSAL GUIDANCE WORKSHEET
(to be completed by manager)
EIN
Manager's
Phone #
This tool is designed to provide you with guidance on important factors to consider when preparing to discipline or
dismiss an employee and may also help you respond to any ADOA requests for additional information.
If the employee is AZ Post certified ensure all notice rights are provided to the employee prior to any investigative
interview.
1. Please summarize the behavior or performance issues that you have been having with the employee.
2. How long has the employee been employed by the State? How long has the employee been in their current job?
3. What steps have you taken to address the employee's unsatisfactory behavior or performance? Note: If
immediate dismissal is sought because of the severity of the incident or for egregious conduct, please provide
details in the 'other' section below.
4. Has the employee received education or training to perform their work? If so, is documentation included in the
employee's file (e.g. resume, job application, certifications, etc.?)
No
Yes
5. When did the unsatisfactory behavior or performance begin? Have you provided the employee time to improve the
unsatisfactory behavior or performance? If so, how long?
ASPS/HRD-FA8.01A 07/19
Performance
Conversations
Performance Evaluation Score &
Comments
Performance Improvement Plan
Evaluation Planner
Letter of Reprimand
Memorandum of Concern
Documentation of Performance
or Behavior Conversations
Other - State in Box Below
Suspension
Employee's Name
Manager's Name
Manager's Email
Address
6. Have performance expectations been clearly communicated to the employee? Have they been documented and
acknowledged in the employee's Performance Evaluation Notes?
Yes
No
7.Has the employee proven their ability to be successful with this type of work in the past? Explain in detail. Is
documentation included in the employee's file (e.g. Performance Evaluations, awards, etc.?)
No
Yes
8... How has the employee demonstrated continued failure to meet acceptable performance or behavior standards?
9. Have you previously received Human Resources guidance regarding this employee?
No
Yes
10. Do you feel additional guidance on how to address the employee's behavior or performance issues would be helpful?
No
Yes
(For further guidance, please contact your agency Human Resources Office or ADOA Human Resources Shared
Services at 602-542-5482)
11. Has the employee mentioned any health issues; had attendance problems; requested, received approval for, or
mentioned the need for Family and Medical Leave Act (FMLA) leave; or requested an accommodation that might be
protected under the Americans with Disabilities Act (ADA)?
Yes
No
(For further guidance, please contact your agency Human Resources Office or ADOA Human Resources Shared
Services at 602-542-5482)
12. Has the employee indicated they feel they are being discriminated against, harassed, or retaliated against, or does the
employee have an open claim filed with the EEOC, Worker's Compensation, OSHA or any other state or federal
agency?
No
Yes
(For further guidance, please contact your agency Human Resources Office or ADOA Human Resources
Shared Services at 602-542-5482)
Manager's Signature
Date
ASPS/HRD-FA8.01A 7/19
click to sign
signature
click to edit