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Download DA Form 4856 for Free | Page 2

The Developmental Counseling Form begins with a section which contains the items of Authority, Principal Purpose, Routine Uses, and Disclosure, and gives a brief introduction of this form. As for the main body of this template, there are four parts, namely, Administrative Data, Background Information, Summary of Counseling, and Assessment of the Plan of Action. This template is pretty practical, and you can download it for your reference for free.

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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)
Individual counseled remarks:
Leader Responsibilities:
(Leader's responsibilities in implementing 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.)
REVERSE, DA FORM 4856, AUG 2010
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.
Signature of Individual Counseled: Date:
Signature of Counselor: Date:
PART IV - ASSESSMENT OF THE PLAN OF ACTION
Individual Counseled: Date of Assessment:Counselor:
Note: Both the counselor and the individual counseled should retain a record of the counseling.
APD PE v1.01ES
DA Form 4856 Page 2
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