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SAMPLE PERFORMANCE IMPROVEMENT PLAN To: Employees Name From: Supervisors Name Re: 2011 Performance Improvement Plan

Date: Date of Meeting Also Present: Witness Name CC: Human Resources, Executive Director, etc. The following job responsibilities were rated as needs Improvement on the 2010 Performance Appraisal for (name of employee). 1) 2) Etc. Action Points: In this section, the supervisor will list action points in relation to the items noted above. The action points must have measurable outcomes by a certain date.

Progress will be discussed and recorded regarding the above on the following dates: The supervisor will note scheduled dates to meet with the employee to review progress on a monthly basis. The supervisor will submit documentation to HR using a written counseling format immediately after each meeting.

Employee Signature

Date

Supervisor Signature

Date

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