Salary Increase Justification Form
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1
2MANAGER’S VERIFICATION OF PERFORMANCE ENHANCED SALARY INCREASES
Manager’s Directions: Only complete Section B if there were no available opportunities afforded to
the MBU under Section A. Please answer each question below with a check mark under either “Y” for
yes or “N” for no in each column. Please also utilize the "PSSA Information Worksheet" to obtain the
required information for Section A.
Employee Name:___________________________
Section A: Professional/Personal Growth and Contribution
Increase of .25% to Base
(Y)
(N)
Has employee volunteered for 2 on or off campus events that are
1
formally sponsored or endorsed by the University from July 1, 2014
through June 30, 2015?
2
Has employee participated in at least 1 University offered technology
application competency (technology related training) from July 1, 2014
through June 30, 2015?
Increase of .25% to Base
(Y)
(N)
Has employee participated in at least 2 supervisor authorized,
1
professional development activities from July 1, 2014 through June 30,
2015?
Section B: University did not provide the minimum number of activities/opportunities in Section A
Increase of .75% to Base
(Y)
(N)
Has employee been formally disciplined, in writing, from July 1, 2014
1
through June 30, 2015?
2
Did employee seek and receive either an extended sick leave or an
extraordinary leave of absence from July 1, 2014 through June 30,
2015?
3
Has employee been on either Workers Compensation or Rhode Island
TDI for more than 3 months from July 1, 2014 through June 30, 2015?
4
Was employee promoted with an increase in salary base within 3
months prior to July 1, 2015?
5
Did employee qualify for 1 personal day because he/she did not utilize
more than 3 sick days from July 1, 2014 through June 30, 2015?
(Note: if response is “Yes”, then response to #3 is void so long as time
out on worker’s compensation is less than 4 months.)
By signing below, I certify that the above information and information contained in the PSSA
Information Worksheet is accurate and correct.
___________________________
__________________________/___________
Manager Print Name
Manager’s signature
Date
For HR Only:
HR Review ________(initials)
Total Increase % _________
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Parent category: Business