Employee Name:__________________________________________________
Meeting Date:_____________________ Dept:______________________________________
Supervisor Name:_________________________________________________
Standard(s) of Performance Reviewed:(check all that apply):
[ ] Productivity | [ ] Efficiency |
[ ] Teamwork | [ ] Quality |
[ ] Attendance | [ ] Conduct |
[ ] Other (define): | |
Specific examples of current performance under review:
Improvement Plan (what is expected, how it should be accomplished, and in what timeframe):
Acknowledgment:
Employee (signature):_______________________ Date: __________________
Supervisor (signature):______________________ Date: ___________________
Periodic Review Notes
Comments | Employee Initials | Supervisor Initials | Date |
1. | |||
2. | |||
3. | |||
4. | |||
5. | |||
6. |
CHECK ONE:
[ ] Performance Action Plan satisfactorily completed on: _______/_______/_______
[ ] Corrective Action Required (attach and submit to Human Resources)
Failure to meet and sustain improved performance may lead to further disciplinary action, up to and including termination. Corrective action may be taken in conjunction with, during, or after the performance plan.
Reviewed and accepted by:
Employee (signature):______________________Date: __________________
Review completed by:
Supervisor (signature):_____________________ Date: __________________
Performance Action Plan reviewed by:
Department Manager (signature):______________ Date: _________________
Human Resources (signature):________________ Date: _________________
This performance plan is not intended to be an employment contract or guarantee of continuing employment.
Copy: Employee
Original: Personnel File
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