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LAWRENCE-DOUGLAS COUNTY FIRE MEDICAL Performance Appraisal and Development Plan

"Committed to Saving and Protecting Lives and Property" Core Values: Compassion and Respect, Community Oriented, Diverse, Professionalism, Teamwork, Leadership

Employee Name: Division: Job Title/Pay Grade:

Review Due Date: Date Completed:Type of Review:Evaluator:

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PERFORMANCE APPRAISAL

Employee reports on time and is ready for duty.

Employee uses accumulated leave appropriately.*b.

a.

Leave UsageI. Supervisor Evaluation

Outstanding

4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0

Total Rating:Ratings of Unacceptable/Needs Improvement/

Commendable/Outstanding must have supporting comments below.

Self Evaluation

Outstanding

4

Commendable

3

Unacceptable

0

Effective

2

Total Rating:

Needs Improvement

1

Ratings of Unacceptable/Needs Improvement/Commendable/Outstanding must have supporting

comments below.

Supervisor Comments:

Employee Comments:

Shift:

(Does not apply to FMLA events or Work Comp)

*Leave Use Rating: Hours (2080): Hours (2912):

Unacceptable 96 - 88.1

288 - 264.1

Needs Improvements 88 - 64.1

264 - 192.1

Effective 64 - 32.1

192 - 96.1

Commendable 32 - 16.1 96 - 48.1

Outstanding 16 - 0 48 - 0

Confidential

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Employee Comments:


Uses constructive feedback to improve performance.

Maintains a neat, clean, and professional appearance.

Displays a positive organizational attitude.

Conducts herself/himself in a professional manner that reflects a positive public image.

Conveys and supports the mission statement of the Department in a professional manner.

e.

d.

c.

b.

a.

Professionalism/Core ValuesII. Self Evaluation Supervisor Evaluation

Outstanding

4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0



Outstanding

4

Commendable

3

Unacceptable

0

Effective

2

Total Rating:

Needs Improvement

1


comments below.

Confidential

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ResponsibilitiesIII.

e.

d.

c.

b.

a.

Properly completes required reports and records in an accurate and timely manner.

Displays initiative to perform tasks and duties without direction or supervision.

Demonstrates proper care and use of equipment and Department vehicles.

Possesses the ability to complete a variety of assignments.

Completes required and/or assigned duties in a thorough and timely manner.

f.

Outstanding

4

Commendable

3

Unacceptable

0

Effective

2

Total Rating:

Needs Improvement

1


comments below.

Self Evaluation Supervisor Evaluation

Outstanding

4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0




Employee Comments:

Follows current departmental policies and procedures.

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Performs essential administrative duties.g.

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Employee Comments:

Attends and participates in drills and in-service training programs to maintain proficiency with changes in equipment, technology, codes, and other skills as required.

Displays an attentive, positive, and participatory attitude during training sessions and company evolutions.

Exhibits good safety practices and judgement during training sessions and company evolutions, and follows specific supervisory directives regarding safety measures.

Displays the ability and desire to work well with other team members and other organizations.

Demonstrates knowledge, skills, and abilities consistent with position.

Displays a willingness to learn new skills and techniques.f.

e.

d.

c.

b.

a.

Training - Self Development and Personal EnhancementsIV. Self Evaluation Supervisor Evaluation

Outstanding

4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0



Outstanding

4

Commendable

3

Unacceptable

0

Effective

2

Total Rating:

Needs Improvement

1


comments below.

Confidential

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Self Evaluation

Outstanding

4

Commendable

3

Unacceptable

0

Effective

2

Total Rating:

Needs Improvement

1


comments below.

Outstanding

4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0



Supervisor EvaluationEmergency Skills / Essential Job DutiesV.

f.

e.

d.

c.

b.

a.

Works effectively as a team member at the emergency scene.

Applies and follows Department Standard Operating Procedures on the emergency scene.

Performs station duties essential to the daily operation of the department.

Remains calm, exercises good judgement, adapts to change, and functions effectively in emergency situations.

Exhibits good safety practices during non-emergency and emergency operations, following supervisory directives regarding safety measures.

Uses proper equipment and methods to protect lives and minimize property loss.


Employee Comments:

Confidential

Self Evaluation

Outstanding

4

Commendable

3

Unacceptable

0

Effective

2

Needs Improvement

1



Supervisor Evaluation

Outstanding

4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0



Interpersonal Relationship and Communication SkillsVI.

g.

f.

e.

d.

c.

b.

a.

Works to establish and maintain a professional image and working relationship with the community.

Demonstrates a customer service attitude consistent with the core values of the Department.

Demonstrates effective written skills; conveys information in a written format that is clear and concise.

Demonstrates effective oral communications skills; conveys ideas and information to people from various backgrounds in a manner that is clear and concise.

Works well with supervisor(s).

Works to create and maintain good working relationships with personnel from other departments, agencies, and organizations.

Cooperates with peers to work effectively and efficiently, helps create and maintain good working relationships, and promotes teamwork.

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Employee Comments:

Confidential

02/2014

Supervisor EvaluationSelf EvaluationSupervisor and ManagementVII.

Outstanding 4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0

Total Rating:

Captains/Division Chiefs Only


comments below.

Displays the ability to interpret, explain, and enforce departmental policies and procedures.

Displays ability to coach subordinates in skills related to company growth and development.

Provides information and addresses rumors with facts.

Properly delegates responsibilities to subordinates.

Effectively supervises and evaluates tasks and accomplishments of subordinates.

Recognizes strengths and weakness of subordinates in order to maintain an effective and efficient company.

Manages time wisely to effectively carry out assigned activities and responsibilities.

g.

f.

e.

d.

c.

b.

a.

h.

i.

Makes emergency management decisions quickly and calmly during stressful situations.

Has sufficient knowledge of subordinates, responsibilities, duties, and performance to effectively supervise them.

Communicates effectively with supervisor(s), regularly sharing information.

j.

Properly communicates all relevant information with on-coming officer.

k.

Adheres to the City of Lawrence and Departments purchasing policy, staying within established budgets.

l.

Demonstrates effective human resource management skills (Performance Appraisals, Risk Management, Personnel, Payroll)

m.

Meets assigned deadlines.

n.

Incident reports are completed, accurately documented, and reviewed.

o.

Performs company level training.

p.

Manages assigned station, apparatus, and equipment to ensure they are clean and in a ready state.

q.

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Outstanding

4

Commendable

3

Effective

2

Needs Improvement

1

Unacceptable

0

Total Rating:



comments below.

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Supervisor and ManagementVII.


Employee Comments:

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Additional / Other Comments

Employee Comments:

Unacceptable

0

Needs Improvement

0.00 - 1.49

Effective Commendable

2.5 - 3.49

Outstanding

3.5 - 4.00

Supervisor's Overall Rating:

Employee's Overall Rating:

These are recommended merit increases based on employee's overall rating: (Members at top of pay scale do not qualify for a merit step increase. Members not covered by merit step program receive merit performance compensation as permitted within merit pool.)

Comments, if any:

1.50 - 1.99

2.00 - 2.49

0% 0% 2.5% 5% 5% 5%Percent Increase:

OVERALL RATING


This section should include those activities that Lawrence-Douglas County Fire Medical members are involved with that are voluntary responsibilities, additional assignments, and or projects.


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Goals - Professional Development and Performance Objectives

1.

PREVIOUS YEAR'S OBEJECTIVES: Identify the previous year's goals, whether they were Professional Development or Performance Objects, how the attainment of these goals was measured and the degree to which the employee attained the goals.

1.

MetDid Not

Meet

Objective Attainment

Previous Year's Objectives Method of Measurement

PerformanceProfessional

Development

Type of Objective

2.2.

3.3.

4.4.

5.5.

6.6.

Comments:

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CURRENT YEARS OBEJECTIVES: The evaluator and employee should mutually agree upon and list professional development and performance objectives for the current year. In the second column, list how the attainment of these objectives will be measured. NOTE: An agreement between the evaluator and employee is not required for an objective to be valid and enforceable.

Method of Measurement

PerformanceProfessional

Development

Type of Objective

Current Year's Objectives

1.1.

2.2.

3.3.

4.4.

5.5.

6.6.

Comments:

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I certify that this performance appraisal has been discussed with me and I have received a copy, if desired.

I understand that if I disagree with my performance rating, I may file an appeal with my immediate supervisor within five (5) calendar days of the date I signed the appraisal.

I have received a current copy of the City of Lawrence - Statement of Individual Respect. I have had the opportunity to review the policy and ask questions regarding reporting procedures and obligations as an employee covered by this policy.

SIGNATURE SECTION

Fire Chief Signature

Division Chief Signature

Supervisor Signature

Employee Signature - Does not necessarily indicate agreement.

Date Signed

Date Signed

Date Signed

Date Signed

I have received a current copy of my Job Description

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I have received a current copy of the City of Lawrence - Email and Internet Use Policy. I have had the opportunity to review the policy and ask questions regarding reporting procedures and obligations as an employee covered by this policy.

I have received a current copy of the Lawrence-Douglas County Fire Medical Policy on Confidentiality and Dissemination of Patient Information and Staff Member Verification. I have had the opportunity to review the policy and ask questions regarding reporting procedures and obligations as an employee covered by this policy.

Employee Initials:

Employee Initials:

Employee Initials:

Employee Initials:

Employee Initials:

Employee Initials:

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