Da Form 4856 - Developmental Counseling Form - 2014 Page 2
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2Plan 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)
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:
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.
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REVERSE, DA FORM 4856, JUL 2014
APD LC v1.02ES
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