Employee Performance Feedback Plan

Employee: Jacqui Supervisor: Simone Date: 11th April 2019

Job Title: HR Aministrator Plan:

[Action Item Title – Goal or Behavior needing improvement]

Needs Improvement: (specific examples)

Description: (details of action employee must take to improve including measurements & due dates)

1st follow up meeting – Date:

Comments: (should give details about how the employees performance is against the above action item)

2nd follow up meeting – Date:

Comments: (should give details about how the employees performance is against the above action item)

Manager’s Assessment – Rating (at conclusion of Action plan)

O Did Not Meet O Met

[Action Item Title – Goal or Behavior needing improvement]

Needs Improvement: (specific examples)

Description: (details of action employee must take to improve including measurements & due dates)

1st follow up meeting – Date:

Comments:

2nd follow up meeting – Date:

Comments:

Manager’s Assessment – Rating (at conclusion of Action plan)

O Did Not Meet O Met

OVERALL ASSESSMENT – RATING (at conclusion of action plan)

O Not Started O Did Not Meet O Met O Not Applicable

Your failure to successfully complete and sustain improvement on the action item(s) listed
above could result in reassignment, demotion, and/or disciplinary action, up to and including
termination of employment.

Signatures for Initiation of Action Plan

Employee: Date:
Supervisor: Date:
Manager: Date:
HR Signature: Date:

Signatures for Closure of Action Plan

Employee: Date:
Supervisor: Date:
Manager: Date:
HR Signature: Date: