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State of Georgia: Performance Management Form
State of Georgia: Performance Management Form
Employee Name: Katrina Jones Emp. ID #: Job Title: Community Support Worker
Manager Name: Tiffany Green Department: Day Program
Review Period: From: 01/17/17 To: 06/30/17
What Sections will you be using in your evaluation?
All Sections (1, 2 and 3) Users must click on the drop down arrow to the left of this field to select which form sections will be included in the overall rating.
Score the performance in each job factor below on a scale of 5-1 or N as follows:
5 = Exceptional Performer Employee exceeded all performance expectations. Employee was an exceptional contributor to the success of his/her
department and the State of Georgia. He/she demonstrated role model behaviors.
4 = Successful Performer-Plus Employee met all and exceeded most (more than 50%) of the established performance expectations.
3 = Successful Performer Employee met all performance expectations and may have exceeded some (less than 50%). Employee was a solid contributor
to the success of his/her department and the State of Georgia
2 = Successful Performer – Minus Employee met most (more than 50%), but failed to meet some performance expectations. Employee needs to further improve
in one or more areas of expected job results or behavioral competencies.
1 = Unsatisfactory Performer Employee did not meet all or most (more than 50%) of the established performance expectations. Employee needs significant
improvement in critical areas of expected job results or behavioral competencies.
N = Not rated: At the agency’s discretion, a new hire or transfer within five months of the end of the performance period may or may not
receive a performance rating.
Teamwork and Cooperation - Cooperates with others to accomplish common goals; works Has met. Works will with her co-worker that is in the same dept.
with employees within and across his/her department to achieve shared goals; treats others sharing information & working together for the common goal of
with dignity and respect and maintains a friendly demeanor; values the contributions of others. serving the clients of TGSC. 5
Results Orientation - Consistently delivers required business results; sets and achieves Has met.
achievable, yet aggressive, goals; consistently complies with quality standards and meets 4
deadlines; maintains focus on Agency and State goals.
Judgment and Decision Making - Analyzes problems by evaluating available information and Has met in bringing forth problems that have been encountered while
resources; develops effective, viable solutions to problems which can help drive the on the job. 4
effectiveness of the department and/or State of Georgia.
Note: Calculate the overall section rating by adding the ratings for the individual items in the Overall Section Rating:
section, and then by dividing that total by the number of items in the section.
4.0
Section Weight (not less than 25%): 25%
Section 2: Individual Goals (Weighting can range from 0% to 75% of total score)
Comments Rating
Goal 1: Make 3 Community Connections within the course of the year to bring back to the Bethany Hospice, YMCA Bingo, Flowers Bakery Tour
Center for the benefit of the individuals to introduce them to more things within their 50
community.
Goal 2:
Goal 3:
Goal 4:
Goal 5:
Note: Calculate the overall section rating by adding the ratings for the individual items in the Overall Section Rating:
section, and then by dividing that total by the number of items in the section. 5.0
Section Weight: 50%
Section 2: Overall Comments:
Comments Rating
Job Responsibility 1: Provide Direct Well-Designed Training that present opportunities 1) Has been doing well in making sure the UB is being reflected
for the Participants to have a Valuable Day while in the within the individuals' ISP. 2) Has met. Services have been
Community: (1). Actively involve Individual's in training or leisure designed to meet client's preferences. 3) Needs work on making
sure that documentation is being made on monitoring
activities during scheduled times and training must be reflective of the
individuals progress & note specifics. 4) Just be mindful to
person's Individualized Service Plan (ISP) & Person Centered; (2). ignore the bad behavior & promote good/positive behavior,
Services are individually designed to meet the participant's needs redirection is appropriate while out in the community. 5) Have
and preferences.; (3) Monitor Individual's progress during training met, by using age appropriate activities to experience. 6) Have
and note specifics relative to progress (improvement, tolerence, met. 7) Have met.
enjoyment, body language, and verbal expressions); (4). Implement
Proactive Measures to Promote Positive Behaviors (presenting
options and activities that interest the person) and Interact with
Individuals using Only Positive Reinforcement (Reward Good 9
Behavior & Ignore Bad Behavior); (5). Use age-appropriate
interaction/activity designed to promote dignity, respect and
independence; (6). All services must be provided off Thomas Grady
Service Center campus or other service sites to be considered
Community Supports 1:1; (7). Provide supervision at all times to
ensure participants safety while in the community (0 tolerance of
neglect). (Report All Progress to Supervisor).
Job Responsibility 2: Complete Documentation of Assigned Individual's accurately Has been doing well with documentation & documenting on
and in a timely manner (according to policy and procedure): (1). training the individual is acquiring while out in the community,
Document using appropriate instruments/forms (Seizure, Behavior, saying in the note whether he is needing more help, hand over
hand, verbal prompt, or independence…working on specific
Fluid and Bowel Elimination, Incidents, Attendance, Observation and
goals i.e. cashing checks, ordering food in restuarant, making
Progress Report); (2). Record all units accurately; (3). Document independent purchases.
progress of all assigned individuals including (increase or decrease in 11
progress, body language and verbal expressions) what training did
the individual accuire while out in the community; was the individual
able to grasp what was being trained and (4). Knowledgeable of all
Instruments/Forms and their location. (Report All Progress to
Supervisor).
Job Responsibility 3: Lead Unit Monitor: (1). Review all Progress Reports to check Has done very well with this job responsibility in giving a variety
accuracy of units; (2). Tally all units and report results to supervisor. of different places to choose from with the client's i.e. places to
(3). Assist the participant in acquiring, retaining, or improving self- eat that individuals may have never been too or thought of
trying b/c they didn't know that they could.
help, socialization, and adaptive skills. (4). Make opportunities for
individuals to Explore and Experience enough times that they will be 10
able to consciously decide if they like or dislike the experience, (1 to 2
times are most often not enough). (Report All Progress to
Supervisor).
Comments
Development Action 1:
Development Action 2:
Development Action 3:
Development Action 4:
Development Action 5:
Supervisor/Manager: Date: