Carroll Hospital Center - Resource Site



| | |PERFORMANCE IMPROVEMENT PLAN |

| | |(To be maintained in department) |

|Associate Name |Date |

|Job Title |Department |

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|Discussion Date: Written Notice Date: |

|Describe the particular concern: |

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|What contributing factors may be impacting the behavior or performance: |

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|Associate Improvement Goals: (Specify the desired outcome the Associate is expected to do to improve). |

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|Evaluation, follow-up, and potential consequences: |

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|Associate’s Feedback/Comments: |

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|A just & learning culture creates an atmosphere of trust in which people are encouraged to explore both the systems-based and behavioral factors contributing to problems and/or performance |

|decrements. People are clear about where the line is drawn between acceptable and unacceptable behavior and performance. However, if this action continues, progressive discipline could result. |

|It is generally expected that discipline will progress through each step in the order set out in Disciplinary Policy. However, where deemed appropriate, the organization may, in its sole |

|discretion, deviate from the normal progression through the steps. Such deviation may include, but is not limited to, initiating the discipline procedure at any step (including immediate |

|separation of employment). Your signature indicates that you have read this form, identified goals for improvement (if applicable) and received a copy. It does not necessarily mean that you |

|agree with any part of this action. |

|Associate Name |Date |

|Manager’s Signature |Date |

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