Employee Name:
Title:
Department
Date:
Performance in need of improvement: (List the goals and activities the employee will initiate to improve performance. Include skill development and changes needed to meet work performance expectations.)
Targeted date for improvement:
Expected results - list measurements, where possible:
Dates to review progress by the employee and supervisor:
Progress at review dates:
Employee Signature:____________________________________________
Date:__________________________________________________________
Supervisor Signature:__________________________________________
Date:
