Performance Development Program
Performance Improvement Plan
Staff Member:
Job Title:
Department:
Date:
JOB RESPONSIBILITIES AND COMPETENCIES
List the staff member’s primary job responsibilities that require attention and describe the specific improvement that is needed to
meet the minimum expectations.
Job Responsibility/Competency:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Specific Improvements Required:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Job Responsibility/Competency:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Specific Improvements Required:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Job Responsibility/Competency:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Specific Improvements Required:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
(Use Additional Sheets if Necessary)
Follow-Up Review to be conducted within
Follow-Up Review Signatures
Staff Member: _________________________________________________________ Date: __________________________
Supervisor: ___________________________________________________________ Date: __________________________
Reviewing Official: ____________________________________________________ Date: __________________________
Follow-Up Review
Staff member has achieved the requirement improvement(s) described above. Yes * No **
Staff Member: _________________________________________________________ Date: __________________________
Supervisor: ___________________________________________________________ Date: __________________________
Reviewing Official: ____________________________________________________ Date: __________________________
*If yes, an additional Performance Improvement Plan is not required but may be appropriate.
**If no, an additional Performance Improvement Plan must be completed and filed.
A copy of this should be attached to the Performance Development Program Annual Review. After the follow-up review is completed, provide a copy
to the employee and forward the original to the Human Resource Department.