Form 0750 Sample - Performance Appraisal Program Page 3
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6SECTION A - PERFORMANCE PLAN (Continued)
PERFORMANCE ELEMENTS/STANDARDS
SAMPLE
CHANGES TO PERFORMANCE PLAN (Changes may be recorded anytime during the rating period)
ELEMENT DESCRIPTION/TITLE
STANDARD (S)
ELEMENT DESCRIPTION/TITLE
STANDARD (S)
SIGNATURE OF RATER
DATE
SIGNATURE OF EMPLOYEE
DATE
(MM/DD/YYYY)
(MM/DD/YYYY)
SECTION B - PROGRESS REVIEW
At least one progress review is required during the appraisal year. Employee must be informed of his/her progress as measured against the
performance plan. Additional progress reviews may be documented on page 6.
A performance review was conducted and discussed, and the employee's performance as of this date:
Is considered Fully Successful or better.
Needs improvement to be Fully Successful or better.
(See VA Handbook, 5013/1, Part I, Paragraph 7, for additional required action.)
SIGNATURE OF RATER
DATE
SIGNATURE OF EMPLOYEE
DATE
(MM/DD/YYYY)
(MM/DD/YYYY)
VA FORM 0750, NOV 2003
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