Free 52405.pdf - Indiana

WORK IMPROVEMENT PLAN
NOTICE OF SUBSTANDARD PERFORMANCE State Form 52405 (9-05)

This form is to be used to address and correct performance deficiencies that arise during the performance review period.

Employee Name Agency/Division Class title/Class code Type of Work Improvement Plan/Follow Up Date: Description of specific performance deficiencies:

Employee ID Number Business Unit Review Period to 30 Days 60 Days 90 Days

Corrective action to be taken: Employee's Responsibility: Manager/Supervisor's Responsibility:

This form documents that you must make timely improvement in the performance of your duties. Failure to improve your performance to at least a "Meets Expectations" level by the prescribed date may result in reassignment, demotion, or termination. Emp. Initials: ____________
Evaluator signature: Employee signature: Reviewer signature: Appointing Authority signature: Date: Date:

To be completed at end of plan period Successful Completion of Work Improvement Plan: Yes No Date: ______________

If No, explain follow up action taken: _________________________________________________________________ Supervisor Initials: ___________ Employee Initials: ____________