Army Separation From Service Counseling Statement

Purpose: Inform the Soldier that he/she is being separated from the Army and the requisite articles and provisions
under which the Soldier is being processed.

Frequency: Upon initiation of separation; follow-on counseling is discretionary upon further adverse behavior

Minimum areas to address:
- Discuss the offenses leading to the decision to separate the Soldier, including the dates of the offenses

- Explain to the Soldier the least favorable discharge he/she may receive as a result of the separation, and some
possible benefits they may lose

Required Actions:
- Initiate separation action at company level, ensure chain of command is aware of intent to separate Soldier

- Ensure commander has completed the
DA 4856 under “Assessment of the Plan of Action” and signed stating
whether or not he agrees with the separation initiation

- Monitor Soldier’s behavior during separation proceedings and initiate further counseling/UCMJ as required

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