Pmpform2002

NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM Performance Management Process Employee Name: Agency: Performance Reporting Period Title: Division: From: SSN: Original Probation: Yes To: No Part I-A - Performance Goals Goals are tailored to the specific results desired from an individual directly linked to the organization’s (division/facility/service area/agency) strategy. Goal should be written to the “meets expectations” level, so if you reach the goal, you will receive that rating for it. Goals should meet the criteria of a SMART goal. Given the dynamic nature of some jobs, goals may need to be revised to reflect changing priorities during the review period. These goals were mutually developed by the employee and his/her immediate supervisor: Employee Signature ________________________________________ Date ____________ Employee’s Immediate Supervisor Signature __________________________ Date ____________ HR-3 Rev. 8/01 (5601) 1 NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM Performance Management Process PART I-B - Goal Evaluation Electronically copy and paste the following evaluation section under each of the goals listed in PART I-A. Rate each goal according to HHSS guidelines. Type an "X" next to the appropriate numeric rating. All goals must include summary comments that support rating. (See HHSS Guidebook for the Performance Management Process for suggestions.) Less Than Expected: Did not achieve all goals as agreed upon. Meets Expectations: Goals were met. Results were obtained. Exceeds Expectations: Results exceed expectations. Responded creatively and positively to unplanned events and new opportunities. Less than Expected Meets Expectations Exceeds Expectations 1 2 3 4 5 Goal Summary Comments: (Required only if behavioral rating is 1 or 5. May reference Performance Note.) HR-3 Rev. 8/01 (5601) 2 NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM Performance Management Process Part II – Behavior Expectations and Evaluation For each behavior type an “X” next to the corresponding rating that is most typical of the employee’s performance over the review period. 1. Enhances Communication (Communication) Less Than Expected: Verbal and/or written communication does not achieve an understanding. Style of relating to others is sometimes inappropriate and creates problems with peers, employees and customers. Does not consistently treat others with dignity and respect. Meets Expectations: Consistently maintains good working relationships with peers, supervisors, customers, stake holders, etc. Always treats others with dignity and respect. Willingly shares information that will enhance the work effectiveness of others. Promotes positive public relations and public image of organization. Strong written and verbal communications. Exceeds Expectations: Meets all criteria mentioned under “Meets Expectations” PLUS may show talent in such areas as persuasion and conflict resolution. Less than Expected Meets Expectations Exceeds Expectations 1 2 3 4 5 Examples of behavior demonstrated: (Required only if behavioral rating is 1 or 5. May reference Performance Note.) 2. Demonstrates Flexibility and Adaptability (Cooperation) Less Than Expected: Resistant to implementation of new approaches. Insufficient sensitivity to and does not show concern about impact of change on peers, employees and customers. Indifferent to the effects of his/her behavior on others. Meets Expectations: Takes proactive role in managing change. Sensitive to and shows concern about impact of change on others. Encourages trust and cooperation. Demonstrates flexibility in accepting additional responsibilities. Exceeds Expectations: Meets all criteria mentioned under “Meets Expectations” PLUS viewed as a change agent. Personally works with others to implement change. Demonstrates flexibility in accepting additional responsibilities while maintaining current workload. Less than Expected Meets Expectations Exceeds Expectations 1 2 3 4 5 Examples of behavior demonstrated: (Required only if behavioral rating is 1 or 5. May reference Performance Note.) HR-3 Rev. 8/01 (5601) 3 3. Fosters Diversity (Collaboration) Less Than Expected: Does not always recognize value of positive relationships with others. Does not value different opinions, experiences, backgrounds and/or cultures. Does not encourage diversity in composition of work teams. Withholds information and assistance. Meets Expectations: Demonstrates a willingness and ability to work with others as team players in the pursuit of common goals. Encourages shared objectives with other workgroups. Values diverse opinions, experiences, backgrounds and cultural styles. Encourages an environment of openness, trust and acceptance. Builds a participative environment. Exceeds Expectations: Meets all criteria mentioned under “Meets Expectations” PLUS assures appropriate linkages between own work plans and organization goals. Facilitates a positive environment. Maintains high level of morale Less than Expected Meets Expectations Exceeds Expectations 1 2 3 4 5 Examples of behavior demonstrated: (Required only if behavioral rating is 1 or 5. May reference Performance Note.) 4. Maintains Focus on Customer Service (Customer Service) Less Than Expected: Not fully attuned to importance of customer. Does not appropriately participate in identifying customers needs. Meets Expectations: Values customers. Consistently meets customers needs. Takes appropriate action to solve customer concerns effectively and efficiently. Exceeds Expectations: Meets all criteria mentioned under “Meets Expectations” PLUS assists others in developing the skills to provide quality customer service. Less than Expected Meets Expectations Exceeds Expectations 1 2 3 4 5 Examples of behavior demonstrated: (Required only if behavioral rating is 1 or 5. May reference Performance Note.) 5. Job Knowledge and Productivity (Confidence) Less Than Expected: Focuses on responsibilities of others more often than own responsibilities. Sometimes fails to follow through on commitments. Demonstrates little or no initiative to acquire skills and knowledge necessary to meet requirements of position. Is not always completely honest or forthright. Work is not completed efficiently or of consistent high quality. Meets Expectations: Takes responsibility for owns actions and actions of workgroup. Works to solve problems. Shows initiative to increase job knowledge. Demonstrates honesty, integrity and fairness. Effectively manages and maximizes talent of all employees; maintains high morale within organization. Work output consistently meets quality and quantity standards for the position. Actively incorporates quality approaches into work. Exceeds Expectations: Meets all criteria mentioned under “Meets Expectations” PLUS demonstrates critically important knowledge that positively impacts results. Establishes a system of continuous improvement focused on improving work performance. Demonstrates very high levels of honesty, integrity and fairness. Less than Expected Meets Expectations Exceeds Expectations 1 2 3 4 5 Examples of behavior demonstrated: (Required only if behavioral rating is 1 or 5. May reference Performance Note.) HR-3 Rev. 8/01 (5601) 4 NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM Performance Management Process Part III: Evaluation Summary Individual Goal Ratings from Part I-B: Goal 1: Goal 2: Goal 3: Goal 4: Goal 5: Add more goals as necessary Sum of numeric ratings Divided by total number of goals Line A: Average numeric rating for goals Rating Behavior Expectation Ratings from Part II: 1. Enhances Communication 2. Demonstrates Flexibility and Adaptability 3. Fosters Diversity 4. Maintains Focus on Customer Service 5. Job Knowledge and Productivity Sum of numeric ratings Divided by 5 (number of expectations) Line B: Average numeric rating for behaviors Line A: Average numeric rating for goals Line B: Average numeric rating for behaviors Sum of Line A and Line B Divided by 2 = Employee Performance Evaluation Score Round to one decimal point. Rating Immediate Supervisor __________________________________________Date _____________ Employee ___________________________________________________ Date _____________ I understand my signature only indicates I have been informed of the contents of the evaluation and discussed it with my supervisor. I am also aware that I have the option to submit written comments (Part V) to be attached within thirty calendar days. HR-3 Rev. 8/01 (5601) 5 NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM Performance Management Process Part IV. Development Plan for to . Strengths and Areas for Development  In evaluating goals and behaviors, what strengths and skills were most evident?  Which of these strengths and/or skills could be further developed?  In what ways could current job performance be improved? Development Plan  Comment on development activities completed during prior evaluation period.  List developmental action steps/accountabilities/target dates for development activities during the upcoming performance year. This development plan was mutually developed by the employee who will implement the plan and the immediate supervisor. Supervisor ___________________________________________________ Date ____________ Employee ___________________________________________________ Date ____________ HR-3 Rev. 8/01 (5601) 6 NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM Performance Management Process Part V. Employee Comments Name: Position: From: To: Use this page to comment on the performance review itself and/or any other aspect of the Performance Review and Development Plan process. Employee Signature ____________________________________________ Supervisory Follow-up Notes (if required): Date ______________ HR-3 Rev. 8/01 (5601) 7 NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM Performance Management Process Performance Note (May be initiated and completed by either immediate Supervisor or Employee) DATE: TO: FROM: SUBJECT: [Use this form to document specific progress toward goals and to provide feedback concerning HHSS behavior expectations. This form is not meant to take the place of regular, face-to-face communications between employee and supervisor. In situations requiring immediate corrective action, this form can be used as a discussion tool and as documentation of action to be taken and required follow-up.] Goal progress or situation encountered: Action taken and/or behaviors demonstrated: Results achieved/corrective action agreed to: Follow-up required (if needed): Employee or Supervisor comments (if any): Reviewed by both supervisor and employee: Supervisor Signature ________________________________________ Employee Signature ________________________________________ Date _____________ Date _____________ HR-4 Rev. 8/01 (56018)