This is the Responsibility Task that I use in my classroom when students end up on the "Responsibility Task" on the Behavior Clip Chart. This document asks the student to note what they did incorrectly, write down how to do it correctly, and explain why it's important to do it correctly. There is also a signed "contract" at the bottom that notes that the student is agreeing to make a change in the future.
After a few of these, intervention on a higher level will be necessary, but this also provides the documentation you would need for any extra support. (It's RTI & PBIS friendly! :D)