Form 5500F2 3/16/2020
Remote Work Individual Work Plan (Form 5500F2)
Employee Name: __________________________________________
Key Outcomes Objective(s) Action(s)/Deliverable(s) Timeline(s) Stakeholders
Information Log
Form 5500F2 3/16/2020
Goal: End result that supports departmental and/or institutional mission and/or value statements.
Outcomes: Results. These describe what someone is able to do as a result of completing a task, training or activity. They are specific and
measurable, in a nutshell someone can perform a certain task and you can see it.
A typical outcome statement has three parts: an action word, the learning content, and the conditions or criteria. For example: Jane Smith will
create documentation on book processing workflows using designated library software and Microsoft Word or “Participants will summarize in writing
their feelings and perspective on cultural diversity in the workplace”. Instead of using “the employee will learn” (which is hard to see and measure),
consider what the employee will be able to do as a result of this learning“Employee will be able to explain or perform, or create, etc. Bloom’s
Taxonomy is a commonly used tool for developing action words.
Objectives: Describe intended result by an activity, i.e., upon viewing and participating in Campus Compacts Equity Webinar, participants
will have an increased understanding of equity gaps in higher education. Or, the creation of training documentation for book processing will enhance
cross-training opportunities among all library staff and improve efficient access to learning materials.
Action(s)/Deliverable(s): Tangible results of the activity, i.e., watch and summarize webinar or training, create documentation using Microsoft
Timeline(s): Summarizes the course of the work and specific deadlines as needed.
Stakeholder(s): Describes who is impacted by the work.
Confidential Information Log: If you are taking confidential and/or information protected by FERPA home, please secure items in a private
location and list items “checked out” and when they are returned.
Helpful Action Words: