/ Winston-Salem/Forsyth County Schools
CLASSIFIED EMPLOYEE PERFORMANCE OBSERVATION - FEEDBACK REPORT
Employee Name: / Supervisor: / Work location:
Job Title: / Date of Observation: / Time:
Performance Dimension(s) Observed (As checked):
Quantity of Work Quality of Work Dependability Safe and Clean Work Area
Customer/Employee Relations/Civility Attendance and Punctuality
Describe the employee’s performance in relation to evaluation standards. (Use attached sheet if needed).
Describe strategies/corrective actions to improve performance dimension(s), if needed.
Timeline for completion:
A copy of this observation – feedback report will be placed in your personnel file. It may affect the ratings you receive on your Performance Evaluation. You are required to sign this report simply to acknowledge its receipt. Your signature does not mean you agree to its contents. You have ten days from the receipt of this report to submit a written response to your evaluator’s observations for placement in your personnel file.
Employee’s Signature: / Date:
Supervisor’s/Evaluator’s Signature: / Date:

P:\law\Forms\HR forms\Classified Observation Report Form Draft date: 8/17/06

Observation - Feedback Report Form

Supervisor Instructions

When documenting observations of an employee’s performance and giving feedback, suggestions and/or corrective actions, it is helpful to use the following steps:

  1. Facts – Describe what you observed. Give concrete examples, when possible, to document the level of performance in relationship to the expected standards of performance set forth on the classified employee evaluation instrument.
  2. Objectives – What is the desired outcome? What do you expect? You may want to cite a portion of the job description or a policy.
  3. Strategies - How do you suggest that he or she improves their performance? Does the employee have any suggestions? You may offer additional training, review of procedures, etc.
  4. CorrectiveActions – If appropriate, tell the employee in writing that he or she is receiving a constructive suggestion(s) to improve his/her performance and set a date to review his or her progress towards obtaining the goals set.

Please use additional forms if the employee has more than one area that needs improvement.

The employee must sign the observation – feedback report form to acknowledge its receipt. If the employee refuses to sign, write “refused to sign” and sign your name as a witness.

The supervisor will give a copy of the signed document to the employee and the original will be submitted to Human Resources to be placed in the personnel file.