Performance Improvement Plan Page 4

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Section Three: Action Plan
Steps to achieve this improvement (training, equipment, feedback, etc.):
Upon establishment of this plan, obtain the following signatures. Give one copy to the employee, one to Human
Resources and maintain one in the departmental file. Failure to achieve and sustain improvement may lead to
further corrective action.
Employee Signature: __________________________________ Date:
_____/_____/_____
Immediate Supervisor Signature: _________________________ Date:
_____/_____/_____
The supervisor must conduct and document a follow-up review 30 to 90 days after the establishment of
the Performance Improvement Plan. This follow-up may indicate a need for an additional review.
Dates of follow-up discussions with employee:

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