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                                            DEVELOPMENTAL COUNSELING FORM
                                                                                For use this form see FM 22-100
                                                                    DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY: 5 USC 301, Departmental Regulations; 10 USC 3013, Secretary of the Army and E.O. 9397 (SSN)
PRINCIPAL PURPOSE: To assist leaders in conducting and recording counseling data pertaining to subordinates
ROUTINE USES: For subordinate leader development IAW FM 22-100 leaders should use this form as necessary
DISCLOSURE: Disclosure is voluntary  
                                                           PART I - ADMINISTRATIVE DATA
Name (Last, First, MI)
Rank/Grade
Social Security No.
Date of Counseling
Organization
Name and Title of Counselor
                                                            PART II - BACKGROUND INFORMATION
Purpose of Counseling: (Leader states the reason for the counseling, e.g. Performance/Professional or Event-Oriented counseling and includes the leaders facts
and observations prior to the counseling)

Event-Oriented: Violation of article 112 (drunk on duty) of the Uniform Code Of Military Justice in that on(date) at (location) you were drunk on
duty(what happened? Describe in detail).
                                                                PART III - SUMMARY OF COUNSELING
                                   Complete this section during or immediately subsequent to the counseling

Key Points of Discussion:

Intoxication while on duty is unacceptable behavior that will not be tolerated. If found guilty of this offense, the maximum
punishment is ______________________. Your reckless behavior jeopardised your personal safety and the safety of
those around you as well as the effectiveness of our unit to successfully accomplish the missions at hand. (I am
recommending that the commander impose nonjudicial punishment for your misconduct) OR (You will receive corrective
training as outlined in the plan of action).


You are here by notified that if this type of conduct continues, actions may be initiated under the Uniform Code of Military
Justice to separate you from the Army prior to your scheduled ETS Date IAW AR 635-200.  If you are involuntary
separated, you could receive an Honorable Discharge, a General (Under Honorable Conditions) Discharge, or a Under
Other Than Honorable Conditions Discharge. If you receive a discharge Under Other Than Honorable Conditions, you will
be ineligible for reenlistment and for most benefits, including payments of accrued leave, transitional benefits, the
Montgomery GI Bill, VA benefits, and You may also face difficulty in obtaining civilian employment.   
                                                                    OTHER INSTRUCTIONS
This form will be destroyed upon reassignment (other than rehabilitative transfers), separations at ETS, or upon retirement. For separation requirements
and                                                                                       notification of loss of benefits/consequenses see local directives and AR 635-200
Download and make changes to DA Form 4856 Counseling for violation of Article 112
(Drunk on duty) of the UCMJ. Requires Pure edge viewer
Army Counseling, Article 112 Drunk on duty: Any member of the armed forces who, is found drunk on duty or drinking alcohol with a Blood
Alcohol Level higher that 0.5 May be punished under article 112.
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Being drunk on duty In the Military is a very serious offence that affects moral and more importantly puts the lives of other Soldiers
and families at risk. This Counseling example is just a guide for those Soldiers that are suspected of having a problem or
showing signs of  becoming a potential threat to unit readiness, in other words this is for that Soldier that shows up for work after
drinking alcohol the night prior to duty and smells like alcohol in your formations. If you suspect that this Soldier is impaired you
should forget about this counseling and take your drunk Soldier to the Troop Medical Clinic TMC to get his Blood Alcohol Checked
and then depending on the results of the blood alcohol test you should recommend him/her for an Article 15 and Army Substance
Abuse Program ASAP referral.
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