EMPLOYEE COMPETENCY CHECKLIST
EMPLOYEE COMPETENCY CHECKLIST
(ANNUAL ASSESSMENT)
Employee Name: _________________________
Title: _________________________
Unit/Department: _________________________
Date current license/certification expires: ____________
Indicate completion by placing a checkmark if required or write N/A if not required.
(ANNUAL ASSEMENT)
Performance Management Form Reviewed and Signed
Departmental Orientation
Competency Evaluation
Skills Checklist/Equipment Checklist
Verification of current licensure/certification (if required)
Professional License
CPR
Commercial Drivers License
State Drivers License
Due to Human Resources WITH PMF
EMPLOYEE CERTIFICATION
I verify that I have received, reviewed, and understand my responsibilities as described in my Performance Management Form.
______________________________________
Employee Signature Date
SUPERVISOR CERTIFICATION
I verify that the above employee has completed all of the above requirements applicable to the review period.
______________________________________
Evaluating Supervisor Date
HR-35 (10/05) Distribution: Original – Human Resources Copy – Competency File
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