6. Have performance expectations been clearly communicated to the employee? Have they been documented and
acknowledged in the employee's Performance Evaluation Notes?
Yes
No
7.Has the employee proven their ability to be successful with this type of work in the past? Explain in detail. Is
documentation included in the employee's file (e.g. Performance Evaluations, awards, etc.?)
No
Yes
8... How has the employee demonstrated continued failure to meet acceptable performance or behavior standards?
9. Have you previously received Human Resources guidance regarding this employee?
No
Yes
10. Do you feel additional guidance on how to address the employee's behavior or performance issues would be helpful?
No
Yes
(For further guidance, please contact your agency Human Resources Office or ADOA Human Resources Shared
Services at 602-542-5482)
11. Has the employee mentioned any health issues; had attendance problems; requested, received approval for, or
mentioned the need for Family and Medical Leave Act (FMLA) leave; or requested an accommodation that might be
protected under the Americans with Disabilities Act (ADA)?
Yes
No
(For further guidance, please contact your agency Human Resources Office or ADOA Human Resources Shared
Services at 602-542-5482)
12. Has the employee indicated they feel they are being discriminated against, harassed, or retaliated against, or does the
employee have an open claim filed with the EEOC, Worker's Compensation, OSHA or any other state or federal
agency?
No
Yes
(For further guidance, please contact your agency Human Resources Office or ADOA Human Resources
Shared Services at 602-542-5482)
Manager's Signature
Date
ASPS/HRD-FA8.01A 7/19
click to sign
signature
click to edit
![]()
