Department of Veterans Affairs PERFORMANCE APPRAISAL …
[Pages:6]Department of Veterans Affairs
PERFORMANCE APPRAISAL PROGRAM
IMPORTANT: For additional information see VA Handbook 5013/1, Part 1. If additional space is needed for any item on this form, use page 6.
EMPLOYEE'S NAME (Last, First, Middle Initial)
PERFORMANCE PLAN AND APPRAISAL OF
POSITION TITLE, SERIES AND NUMBER
GRADE/SALARY
DEPARTMENT/OFFICE
LOCATION
DATE ASSIGNED PRESENT POSITION
DUE DATE OF WITHIN-GRADE INCREASE
PERIOD COVERED BY THIS APPRAISAL
FROM
TO
SIGNATURE AND TITLE OF RATER PREPARING THIS PERFORMANCE PLAN
DATE
SIGNATURE OF EMPLOYEE
DATE
SECTION A - PERFORMANCE PLAN Reflect the performance elements for the position to be rated. An element is defined as a component of a position that is sufficiently important to warrant written appraisal. Normally each position has four or five elements. Designate with an asterisk the element(s) considered critical. Specific performance standards must be written for each element. There are usually three to five performance standards for each element. When writing performance standards, only the fully successful level of achievement need be defined.
1. ADPAC Functions (*Critical Element): Assists in the refinement of menu and recipe development through NFS computer programs Enters Standing Orders and Supplemental Feeding titles as requested by clinical staff and approved by NFS management. Serves as departmental Technical Assistant Coordinator (TAC) by assisting users in reporting or resolving computer software and hardware problems Assists in training NFS employees in use of hardware or software Assists in coordinating new hardware or software programs Manages S: drive and provides appropriate access to folders for new employees Serves as departmental e-mail group coordinator for VistA and Outlook; adds users to mail groups Serves as coordinator of VistA menus and keys Assigns menus and keys for employees Uses technology to enhance processes and decision-making Completes all tasks in a timely manner
2. Building a Culture of Ownership on a Foundation of Values (*Critical Element): a. Serves on committees/task forces/ad hoc groups in a productive manner b. Fosters an environment within the department and PVAMC as a whole which enhances employees' morale and sense of pride in their work. Utilizes appropriate communication tools to create a culture of ownership within the department rms management of important or sensitive matters which could escalate by providing timely briefings on developments, policies or issues related to NFS. Practices acceptable standards of performance within NFS. d. Oral and written communication will be both effective and efficient at various levels of education and competence e. Supports the departmental vision, aligned with the larger framework of PVAMC Mission and Vision that integrates key organizational and program goals f. Adjusts to and assesses changing situations, implementing innovative solutions to make departmental improvements Executes innovative solutions or develops processes/systems that successfully move the department forward in the delivery of nutrition care
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g. Balances change and continuity; continually strives to improve service and program performance; creates a work environment that encourages creative thinking, collaboration and transparency; and maintains program focus, even under adversity
Promotes a working environment characterized by civility and respect Demonstrates efforts to improve and promote excellence in patient-centered care h. Focuses on measurable outcomes that have clearly defined measures, targets and timelines
3. Customer Service/Satisfaction (*Critical element) a. Consistently responds to customers' requests for assistance promptly and in a friendly and cooperative manner. Any deficiencies in this area are limited and minor and have no significant adverse impact on either organizational or individual productivity or efficiency. b. Relationships within the organization must be consistently courteous and cooperative in nature and overall contribute to the effective operation of the office. c. Performance must demonstrate the ability to adjust to change or work pressure in a pleasant manner, handle differences of opinion in a businesslike fashion, follow instructions conscientiously and to function as a team member, helping the group effort where possible. d. Promotes effective interpersonal relationships as a team member by keeping team members informed of progress/problems, making timely recommendations for improvements, completing tasks and addressing barriers to work appropriately. e. Facilitates collaboration, cooperation, teamwork and supports constructive resolution of conflicts. f. Negotiates with individuals and groups internally and externally as appropriate. Develops a professional relationship with other services. Demonstrates positive collaborations with internal and external customers which results in achieving the overall goals of the Service. Provides specific examples of use of effective collaboration to meet or exceed goals of the Service. Demonstrates the ability to explain, advocate and express facts and ideas in a convincing manner. g. Assists and supports implementation of strategies that are Veteran Centric. Works in collaboration with consultant providing information on staffing levels, existing equipment and feasibility of implementing room service versus alternate options.
4. Safety Practices (Non-Critical) a. Demonstrates a working knowledge of safety procedures by appropriately addressing safety hazards throughout the PVAMC. b. Adheres to information security and privacy compliance guidelines Accepts full responsibility for all transactions under his/her access verify codes and protection of equipment, hardware or software. Uses access security code(s) only in the performance of official duties Accepts full responsibility for protecting electronic and printed files containing sensitive information Protects information from unauthorized release, loss, alteration or deletion, following applicable regulations and instructions in the computer access agreement c. Maintains all databases including food preference/allergy database in VistA
5. Special Projects and Communication (Non-Critical) a. The department values education as a means to improve skills and quality of service. This is accomplished by assuring completion of assigned in-services and training activities b. Demonstrates compliance with mandatory training programs and service specific training programs through the VA Talent Management system and/or internal training documentation c. Completes required continuing education to maintain good standing with the Commission of Dietetic Registration (CDR)
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PERFORMANCE ELEMENTS/STANDARDS
SECTION A ? PERFORMANCE PLAN (Continued).
CHANGES TO PERFORMANCE PLAN (Changes may be recorded anytime during the rating period)
ELEMENT DESCRIPTION/TITLE
STANDARD(S)
ELEMENT DESCRIPTION/TITLE STANDARD(S)
SIGNATURE OF RATER
DATE
SIGNATURE OF EMPLOYEE
DATE
SECTION B - PROGRESS REVIEW At least one progress review is required during the appraisal year. Employee must be informed of his/her progress as measured against the performance plan. Additional progress reviews may be documented on page 6.
A performance review was conducted and discussed, and the employee's performance as of this date: Is considered Fully Successful or better.
Needs improvement to be Fully Successful or better. (See VA Handbook, 5013/1, Part I, Paragraph 7, for additional required action.)
SIGNATURE OF RATER
DATE
SIGNATURE OF EMPLOYEE
DATE
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SECTION C-1 - ACTUAL ACHIEVEMENT
Indicate the single, overall level of achievement that best describes the employee's performance for each ELEMENT shown in Section A. Do not
indicate achievement for each individual standard. Specific examples of performance must be provided in the space below for each element
where a level of achievement other than Fully Successful has been assigned. Assignment of the Exceptional level means that Fully Successful
performance standards have been significantly surpassed. This level is reserved for employees whose performance in the element far exceeds
normal expectations and results in major contributions to the accomplishment of organizational goals.
LEVELS OF ACHIEVEMENT
ELEMENTS
(Use the same keyword description for each element as in Section A)
EXCEPTIONAL
FULLY SUCCESSFUL
LESS THAN FULLY
SUCCESSFUL
Program Administration (*Critical Element)
Customer Service/Satisfaction (*Critical Element)
Special Projects and communications (*Critical element)
Safety Practices (Non-Critical)
Education (Non-Critical)
Describe specific examples of performance for each element where a level of achievement other than Fully Successful has been assigned above. Specific achievements at the Fully Successful level may be described
ELEMENTS/ACHIEVEMENT(S)
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NARRATIVE SUMMARY - OPTIONAL (Provide any additional significant accomplishments, as well as other factors such as details or training experiences related to the overall performance plan. Capacity to assume a more responsible position may also be addressed.)
TYPE OF RATING: ANNUAL RATING OF RECORD
PERIOD COVERED BY THIS APPRAISAL:
SECTION D - OVERALL RATING
SPECIAL RATING OF RECORD
SUMMARY RATING (POSITION CHANGES ? EMPLOYEE OR RATER
FROM:
TO:
NOTE: Recommended Performance Rating - Using achievement levels assigned in Section C and the criteria described below, check
the appropriate rating.
PERFORMANCE RATING
OUTSTANDING - Achievement levels for all elements are designated as Exceptional.
EXCELLENT - Achievement levels for all critical elements are designated as Exceptional. Achievement levels for non-critical elements are designated as at least Fully Successful. Some, but not all, non-critical elements may be designated as Exceptional.
FULLY SUCCESSFUL - The achievement level for at least one critical element is designated as Fully Successful. Achievement levels for other critical and noncritical elements are designated as at least Fully Successful or higher.
MINIMALLY SATISFACTORY - Achievement levels for all critical elements are designated as at least Fully Successful. However, the achievement level(s) for one (or more) noncritical elements is (are) designated as Less Than Fully Successful.
UNSATISFACTORY - The achievement level(s) of one (or more) critical elements(s) is (are) designated as Less Than Fully Successful.
SIGNATURE AND TITLE OF RATER
DATE
SECTION E - HIGHER LEVEL REVIEW/APPROVAL Required only for Minimally Satisfactory and Unsatisfactory ratings of record; unless organization has chosen to have higher level approval required for Outstanding ratings of record.
Concur with recommended rating. Do not concur with rating.
BASIS FOR PERFORMANCE RATING CHANGE
SIGNATURE AND TITLE OF APPROVAL OFFICIAL
A copy of this performance appraisal was given to me.
SIGNATURE OF EMPLOYEE
DATE DATE
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USE THIS AREA FOR ANY ADDITIONAL INFORMATION
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