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DEPARTMEN T OF HEALT H AN D HUMA N SERVICES HH S EMPLOYEE PERFORMANCE APPRAISA L PLAN

HHS Employee Performance Appraisal Plan Warm Springs Health & Wellness Center. DEPARTMEN T OF HEALT H AN D HUMA N SERVICES HH S EMPLOYEE PERFORMANCE APPRAISA L PLAN (See HHS-704A , "Performance Management Appraisal Program", for additiona l information.). I.

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DEPARTMEN T OF HEALT H AN D HUMA N SERVICES HH S EMPLOYEE PERFORMANCE APPRAISA L PLAN

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  1. HHS Employee Performance Appraisal Plan Warm Springs Health & Wellness Center DEPARTMENT OFHEALTH AND HUMAN SERVICES HHS EMPLOYEE PERFORMANCE APPRAISAL PLAN (See HHS-704A, "PerformanceManagementAppraisalProgram", for additional information.) I. PERFORMANCEPLANDEVELOPMENT,MONITORINGAND APPRAISAL A. Performance PlanDevelopment - EstablishesAnnualPerformanceExpectations [NOTE:The employee's signature does not indicate agreement; only that the plan has been communicated.] RATINGOFFICIAL'S SIGNATUREDATE DATE REVIEWINGOFFICIAL'S SIGNATURE(If required by OPDIV Head) EMPLOYEE'S SIGNATURE DATE B. Progress Review - Written narrative required if performance on any element is less thanFullySuccessful. DATE RATINGOFFICIAL'S SIGNATURE DATE EMPLOYEE'S SIGNATURE C. SummaryRating - Section II, Critical Elements, mustbe completed in order to generate thisSummary Rating. [NOTE:The employee's signature does not indicate agreement; only that therating has been communicated.] Exceptional Fully Successful Minimally Successful Unacceptable RATINGOFFICIAL'S SIGNATURE DATE DATE REVIEWINGOFFICIAL'S SIGNATURE(If required by OPDIV Head) (Required if rating is Unacceptable) EMPLOYEE'S SIGNATURE DATE HHS-704B (12/10) PSC GraphicArts (301) 443-1090 EF PAGE 1OF 8

  2. HHS EMPLOYEE PERFORMANCEPLAN(continued) II. CRITICAL ELEMENTS The followingguidance will be followedindetermining an overall summary rating: Aratingwillbeassignedtoeachcriticalelement(AdministrativeRequirements(PartA.ofthisSection)andtheindividualcriticalelements undertheIndividualPerformanceOutcomes(PartB.ofthisSection)).Thisratingwillbebasedupontheextenttowhichtheemployee's performance metone ofthe "Performance Standards" defined in Section V.(Exceptional, Fully Successful, Minimally Successful, and Unacceptable). Therating level definitions will beassigned anumerical score as follows: Exceptional (E): 5 points, FullySuccessful (FS): 3 points, MinimallySuccessful (MS): 2 points, Unacceptable (U): 1 point NOTE:Performanceplansmustincludeoneormoreoutcomes*thatincludeortrackbacktothe"OneHHS"ProgramandManagement Objectives.This cascading approach should ensure thatperformance plans forall employees support the organizational goals ofthe agency.Any"cascade"elementshouldbeidentifiedinthefollowingwayundertheappropriateoutcomeintheperformanceplan:"This element also relates toand supports objectives in the "One HHS" Program and Management Objectives, specifically [citethe specific objective]." *Theoutcomesmaybe AdministrativeRequirements and/or IndividualPerformance,butatleastoneoutcomemustincludeortrackbacktothe"One HHS" Program and ManagementObjectives. A. ADMINISTRATIVE REQUIREMENTS - CRITICAL ELEMENT NOTE:The supervisor should determine, by marking the appropriate box(es), which aspects ofthis critical element apply tothe employee's job duties and responsibilities. For Managers/Supervisors&TeamLeaders** Managers will actively engage in the hiring process with their servicing human resources specialist(s) from the prerecruitment consultationphasethroughon-boarding. Thiswouldincludeensuringtheestablishedhiringprocess timelines are met. Leadsinaproactive,customer-responsivemannerconsistentwithOPDIV/STAFFDIVvisionandvalues:ascertains customer needs/requirements; solicitsfeedback; and makes appropriate adjustments. Communicates program and management goals tostaff;identifies targeted results/outcomes, and timeframes. Allocates and adjusts resources in response to workload and priority changes. Plans, organizes, and assigns unit work. Establishes employee performance plans, and completesrequiredreviews and finalratings. Appropriatelyrecognizes and rewards employee performance. Assesses employees' individual developmental needs, and provides developmental opportunities to staff. Ensuresemployeeawarenessof,andcompliancewith,requirementsrelativetoethics,financialdisclosure,avoiding conflictsofinterest, standardsofethical conduct, political activity,and procurement integrity. DemonstratessupportforEEO/diversityandemployeeworklifequalityandfostersacooperativeworkenvironment where diverse opinions are solicited and respected. Participates in updating and implementing succession plans for current and futurestaffing needs. Seeksresolutionofworkplace conflictsatearliest stage. Conducts program assessments and evaluations to ensure objectives were met. Whereapplicable,ensuresthatHHS,OPDIV,andprogramgoalsandrequirementsforcorrectinggrant,procurement, and finance systemweaknesses are achieved or exceeded. Other aspects (describe): ** To be applied only to Team Leaders who have official position descriptions identifying them as team leaders. (Summary Rating Elements,continued) HHS-704B (12/10)

  3. HHS EMPLOYEE PERFORMANCEPLAN(continued) II. CRITICAL ELEMENTS(continued) A. ADMINISTRATIVE REQUIREMENTS - CRITICAL ELEMENT(continued) NOTE:The supervisor should determine,by markingthe appropriatebox(es),whichaspectsof this criticalelementapplyto the employee's job duties and responsibilities. For All Staff Providesresponsiveservice to internal/external customers that supportcustomer and program requirements. Participates with supervisor in establishing individual performance plans, and provides self-assessments if required. Demonstrates integrity and adheres to Government-wideand HHS Standardsof Ethical Conduct, including but not limited to, avoiding conflictsofinterest, participation in outside activities, political activity, financial disclosure, and use ofgovernment resources and equipment. Treats others with respect; fosters acooperative environment where differences and similarities in opinions are encouraged and communicated. Identifies and communicates individual developmental needs consistent with the agency mission; assists coworkers by mentoring, advising, or guiding them in understanding work assignments as appropriate. Actively participates in identifying, communicating, and implementing quality improvements that ensure attainment of workforce goals. When applicable, identifies and addresses weaknesses in grant system(s),procurement systems,and finance offices to ensure recoveryofimproper payments and to reducethe number ofimproper payments made by the Department. Other aspects (describe): ELEMENT RATING E(5) FS(3) MS(2) U(1) Administrative Requirements B. INDIVIDUALPERFORMANCEOUTCOMES- CRITICAL ELEMENTS Individual PerformanceOutcomes(List individual critical elements) ELEMENT RATING E(5) FS(3) MS(2) U(1) 1. NOTE:Asper HHS Policy,thefollowing element must track to theOne HHS Program and ManagementObjectives. Description: (Summary Rating Elements,continued) HHS-704B (12/10)

  4. HHS EMPLOYEE PERFORMANCEPLAN(continued) II. CRITICAL ELEMENTS(continued) B. INDIVIDUALPERFORMANCEOUTCOMES- CRITICAL ELEMENTS(continued) Individual PerformanceOutcomes(List individual critical elements) ELEMENT RATING E(5) FS(3) MS(2) U(1) 2. Description: E(5) FS(3) MS(2) U(1) 3. Description: E(5) FS(3) MS(2) U(1) 4. Description: (Summary Rating Elements,continued) HHS-704B (12/10)

  5. HHS EMPLOYEE PERFORMANCEPLAN(continued) II. CRITICAL ELEMENTS(continued) B. INDIVIDUALPERFORMANCEOUTCOMES- CRITICAL ELEMENTS(continued) Individual PerformanceOutcomes(List individual critical elements) ELEMENT RATING E(5) FS(3) MS(2) U(1) 5. Description: III. CONVERSION OFELEMENTSTO SUMMARY RATING Afterratingandassigningascoretoeachcriticalelement,theratingofficialwilltotalthepointsanddividebythenumberof criticalelements,toarriveatanaveragescore(uptoonedecimalplace).Thisscorewillbeconvertedtoasummaryrating based on thefollowing point values: Total PointValue:Dividedby Number of Critical Elements:=Average Score: AverageScore will be calculated up to 1 decimal place. This numerical score will then be converted to aSummary Rating, as follows: 4.4 to 5 points 3 to 4.3 points 2 to 2.9 points 1 to 1.9 points Exceptional: Fully Successful: Minimally Successful: Unacceptable: ThisSummary Rating will be recorded on Page1of this form. Exceptions to the mathematical formula: .IfanemployeereceivesMinimallySuccessfulononeormorecriticalelements,he/shecannotreceiveasummary ratingofhigher thanFullySuccessful,regardlessof the average point score. .Asummary rating ofUnacceptable mustbe assigned toany employee who is rated Unacceptable on any critical element. HHS-704B (12/10)

  6. HHS EMPLOYEE PERFORMANCEPLAN(continued) IV. WRITTEN NARRATIVE For progress review and/or summaryrating.Optional, unless performance is below FullySuccessful. HHS-704B (12/10)

  7. HHS EMPLOYEE PERFORMANCEPLAN(continued) V. PERFORMANCESTANDARDS Exceptional (E): The employee performed as a model ofexcellence by surpassing expectations. Indicators ofperformance atthis level includeoutcomesthatexceedFullySuccessfullevelstandards,forcriticalelementsdescribedintheannualperformance plan, and as measured by appropriate assessment tools.Examples include: • • Innovations, improvements, and contributions tomanagement, administrative, technical, or other functional areas that impact outside the work unit and facilitate organizational recognition; • Increases in office and/or individual productivity; • Improved customer, stakeholder, and/or employee satisfaction, resulting in positive evaluations, accolades, and recognition; methodology is modeled outside the organization. Flexibility and adaptability in responding tochanging priorities, unanticipated resourceshortages, or other obstacles; • Initiationof significantcollaborations, alliances, and coalitions; • Leadership on workgroups or teams,such as those thatdesign or influence improvements in program policies processes, or other key activities; • Anticipatestheneedfor,andidentifies,professionaldevelopmentalactivitiesthatpreparestaffand/oroneselftomeet future workforce challenges; and/or • Consistentlydemonstratesthehighestlevelofethics,integrityandaccountabilityinachievingspecificHHS,OPDIV,or programs goals; makesrecommendations that foster clarification and/or influence improvements in ethics activities. • • Fully Successful (FS): • The employee metall critical elements, as described in the annual performance plan, and as measured by appropriate assessment tools.Examples include: • Planned, well-organized, and complete work assignments that reflect requirements; • Decisions and actions thatdemonstrate organizational awareness including knowledge ofmission, function, policies, technologicalsystems,and culture; • Independentlyfollows-uponactionsandimprovementsthatimpacttheimmediateworkunit;establishesandmaintains strong relationships with employees and/or clients; understands their priorities; balances their interests with organizationaldemandsandrequirements;effectivelycommunicatesnecessaryactionstothemandemployee/customer satisfaction is conveyed; • Whenserving on teams and workgroups, contributions are substantive and completed according to standards; • Resolution ofoperational challenges and problems without assistance from higher-level staff; • Acquires new skills and knowledgethroughtraditional and other means to meet assignment requirements; and/or • Demonstration ofethics, integrity and accountability that achieve HHS and agency goals. • Minimally Successful (MS): • Theemployeehaddifficultiesinmeetingexpectations.Thisistheminimumlevelofacceptableperformanceforretentionon the job. Improvement is necessary. Examples include: • Occasionallyfails to meet assigned deadlines; • Work assignments occasionally requiremajorrevisions or often requireminorrevisions; • Applicationof technicalknowledge to completionofwork assignments is not reliable in manycases; • Occasionallyfails to adhere to required procedures, instructions, and/or formats in completing work assignments; • Occasionallyfails to adapt to changes in priorities, procedures or program direction; and/or • The employee has minimal impact on program performance, productivity, morale, organizational effectiveness and/or customersatisfaction. • Unacceptable (U): • The employee failed to meet expectations. Immediate improvement is essential for job retention.Examples include: • Consistently fails to meet assigned deadlines; • Work assignments often requiremajorrevisions; • Fails to apply adequate technicalknowledge to completionofwork assignments; • Frequentlyfails to adhere to required procedures, instructions and/or formats in completing work assignments; and/or • Frequentlyfails to adapt to changes in priorities, procedures or program direction. HHS-704B (12/10)

  8. HHS EMPLOYEE PERFORMANCEPLAN(continued) HHS PERFORMANCEPLANINSTRUCTIONS PerformancePlan All elements of the performance plan are critical.Establishedrequirementsmust support HHS goals and objectives. All employees will be rated on the Administrative Requirements critical element (PartII.A.ofthe plan). Inaddition, the supervisor, with input from the employee, will develop and establish specific outcomes in support ofAgency strategic initiatives to be included as critical elements in theIndividualPerformanceOutcomessection (PartII.B. of the plan). The performance plan should be signed and dated by thesupervisor and the employee in PartI.A. prior to implementation. Progress Review Supervisorswillconductatleastoneprogressreview,atapproximatelythemidpointintheappraisalcycle.Thesupervisor mustprovidewrittendocumentationifperformanceonanyelementislessthanFullySuccessful.Thesupervisorandthe employeeshouldsignanddatePartI.B.afteraprogressreviewisconducted.Iftheemployeerefusestosign,thesupervisor should annotate the form, "Employee declined to sign.Progressreviewconducted on [date]." Performance Appraisal Thesupervisorwillassignaratingtoeachcriticalelement(AdministrativeRequirementsandtheindividualcriticalelements under theIndividualPerformanceOutcomes).Therating level definitions will be assigned a numerical score as follows: Exceptional: Fully Successful: Minimally Successful: Unacceptable: 5 points 3 points 2 point 1 points Afterratingandassigningascoretoeachcriticalelement,theratingofficialwilltotalthepointsanddividebythenumberof criticalelements,toarriveatanaveragescore(uptoonedecimalplace).Thisscorewillbeconvertedtoasummaryrating based on thefollowing point values: Exceptional: Fully Successful: Minimally Successful: Unacceptable: 4.4 to 5 points 3 to 4.3 points 2 to 2.9 points 1 to 1.9 points • Exceptions to the mathematical formula: • Ifan employee receives Minimally Successful on one or more critical elements, he/she cannot receive a summary ratingofhigher thanFullySuccessful,regardlessof the average point score. • Asummary rating ofUnacceptable will be assigned toany employee who is rated Unacceptable on any critical element. • IfrequiredbytheOPDIVHead,thesupervisorwillsubmittheratingtothereviewingofficialforconcurrence.Thesupervisor willconductaperformancediscussionwiththeemployee.ThesupervisorandemployeeshouldsignanddatePartI.C.The employeewillbeprovidedwithacopyofthecompletefinalratingofrecord.Iftheemployeerefusestosign,thesupervisor should annotate the form, "Employee declined to sign. Rating discussed and copy provided on [date]." • A copy will be provided to the employee and the original forwarded to the designated individual within theOPDIV. HHS-704B (12/10)

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