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Department of Health and Human ServicesWork Plan
Division/InstitutionSection/UnitEmployee's Name:Position:Supervisor's Name:Position:Appraisal is for period of: to Date of Performance Planning Discussion:Date of Interim Review Discussion:Date of Performance Appraisal Discussion:
Provide photocopies of signed form to Employee, Manager, and the Personnel Office
 
Performance Management Work Plan
Employee'sSignature DateSupervisor'sSignature DateManager'sSignature Date
Combined KRR Rating
 
KeyResponsibilities/ResultsResultExpectationsTrackingSource/FrequencyActualResultsRatingComments
 
Performance Management Work Plan
Employee'sSignature DateSupervisor'sSignature DateManager'sSignature Date
Combined Dimensions Rating
 
DimensionsBehavioralExpectationsTrackingSource/FrequencyActualResultsRatingComments
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