QUARTERLY PERFORMANCE REVIEW REPORT DEPARTMENT NAME: ____________________ DEPARTMENT NO.: ___________ QUARTER ENDING: _______________ DEPARTMENT HEAD SIGNATURE: ______________________________ w:/jcaho/misc/perform.doc PERF. IF STANDARD(S) WAS NOT MET 1 EMPLOYEE NAME POSITION JOB TITLE EVALUAT’N PLEASE BRIEFLY DESCRIBE ACTIONS NO. SCORE WHAT STANDARD AND/OR WHY A B C D E PERFORMANCE FOLLOW-UP FROM PREVIOUS QUARTER 1 2 EMPLOYEE NAME POSITION JOB TITLE REASONS FOR FOLLOW-UP ACTIONS OUTCOME NO. A B C D E S P R T 1- Actions: A= Counseling B= Education done by the Education Department C= Education done by your Department D= System or process review E= Job observation 2. Outcome: S= Satisfactory performance P= Progressive discipline / Learning Contract R= Resignation T= Termination QUARTERLY PERFORMANCE REVIEW REPORT INSTRUCTIONS FOR USE WHAT This report replaces the current Quarterly Clinical Competence Report. The top part reports on individual performance reviews held during that quarter. The bottom part reports on follow-up of performance problems that were reported in the previous quarter. The employees' names are confidential to the manager and Human Resources. WHY The report serves two purposes: • to enable Human Resources to provide a general summary of employee performance reviews to the Board annually; • to enable the Education Department to identify housewide trends in staff competence. WHO This report is filled out by all managers, both clinical and non-clinical. WHEN This report is filled out quarterly and sent to Human Resources within two (2) weeks after the end of the quarter. WHERE The report form is available as W:\Public\Perform or from your Human Resources Manager. HOW The Top part of the report should be completed throughout the quarter as individual performance reviews are done. The Bottom part can be completed throughout the quarter or at the end of the quarter. Please check the next session for detailed instructions on completing the report. TO COMPLETE THE TOP PART Please follow these instructions after each of your employee performance reviews: First Four Columns Please fill in w reviewed employee's name w position number w job title w overall performance evaluation score Standards w If you rated the employee as "meets standard" or "exceeds standard" for all evaluation standards, then leave the Standards Not Met and Planned Actions entries blank for that employee. w If you rated the employee as "below standard" on any of the evaluation standards, briefly summarize in the Standards Not Met column. Planned Actions In the Planned Actions column, check the actions you plan to take during the next quarter to improve the employee's performance: A= Counseling: discussion between manager and employee about the performance problems and what will be done about it B= Education done by Education Department: education provided through the Education Department (please note that you will need to call Donna Kulawiak to request the Education Department's assistance). C= Education done by your Dept: inservice or job coaching provided by someone in the department. D= System/Process Review: an analysis of the process (rather than the individual) to determine how it can be made more effective/efficient. E= Job Observation: on-the-job observation of the employee's performance by a supervisor. TO COMPLETE THE BOTTOM PART Please refer to the previous quarterly report. Follow these instructions for each employee who did not meet one or more standards in the previous quarter: First Three Columns Please fill in: w reviewed employee's name w position number w job title Reasons for Briefly describe the performance problem. Follow-up Actions Taken Check the column(s) for the action(s) you took (A-E, as above). Outcome Check the final outcome of your follow-up actions: S = Satisfactory Performance: The performance problem no longer exists. P = Progressive Discipline / Learning Contract: The progressive discipline process or Learning Contract has been initiated. R = Resignation: The employee has resigned. T = Termination: The employee has been terminated. If you have any questions, please contact your Human Resources Consultant.
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