Performance Improvement Plan (PIP #1)

Employee Name:__________________________________________________

Meeting Date:_____________________ Dept:______________________________________

Supervisor Name:_________________________________________________

Standard(s) of Performance Reviewed:(check all that apply):

Specific examples of current performance under review:

Improvement Plan (what is expected, how it should be accomplished, and in what timeframe):

Acknowledgment:

Employee (signature):_______________________ Date: __________________

Supervisor (signature):______________________ Date: ___________________

Periodic Review Notes

CHECK ONE:

[ ] Performance Action Plan satisfactorily completed on: _______/_______/_______

[ ] Corrective Action Required (attach and submit to Human Resources)

Failure to meet and sustain improved performance may lead to further disciplinary action, up to and including termination. Corrective action may be taken in conjunction with, during, or after the performance plan.

Reviewed and accepted by:

Employee (signature):______________________Date: __________________

Review completed by:

Supervisor (signature):_____________________ Date: __________________

Performance Action Plan reviewed by:

Department Manager (signature):______________ Date: _________________

Human Resources (signature):________________ Date: _________________

This performance plan is not intended to be an employment contract or guarantee of continuing employment.

Copy: Employee

Original: Personnel File