Status:
Resolved
Other (explain)
*If not resolved after 90 days, contact Human Resources to determine appropriate action.
Follow-up Review Signatures:
Employee Signature: __________________________________ Date:
_____/_____/_____
Immediate Supervisor Signature: _________________________ Date:
_____/_____/_____
Upon completion of this plan, obtain the following signatures. Give one copy to the employee, one to Human
Resources and maintain one copy in the departmental file. Failure to achieve and sustain improvement may lead
to further corrective action.