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PERFORMANCE APPRAISAL PROGRAM

PERFORMANCE PLAN AND APPRAISAL OF


Ei,IPLOYEE S NAME ,/.rrr. I trit. \ltltll, ltiliol)
Mitchell, Oliver B lll
POSITION TITLE. SERIES AND Nt]MBER
Patient Services Assistant Series 303
DEPARTN4ENT,'OFFICE
VA GLAHCS West Los Anoeles
DATE ASSIGNED PRESENT POSITION DUE DATE OF WITHIN.GRADE INCREASE PERIOD COVERED BY THIS APPRAISAL
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SIGNATURE OF E[,4PLOYEE
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SECTION .\. PERFORNIANCE PLAN
pcrlirrtnancc startchrcls, only the tully succcsstul lclel ofachicvcntcnt necd be cletlne{.
PERFORMANCE ELEI\,IENTS/ STANDARDS
l. Patient Processing and Scheduling
1. Every request is thoroughly reviewed to assure it is not a duplicate and the study hasn,t
already been performed.
2. Follows verbal and written instructions from the Administrative Officer and Ghief,
lmaging Service (or designees), regarding the handling, tracking and processing
of requests
for studies.
3. Patient waiting time in the waiting room is informally monitored and tracked, and
technologist supervisors are alerted when patients
have not been seen timely.
Fully Successful: No more than two instances during the appraisal year where requests are
incorrectly scheduled for any reason, or patients have experienced excessive wait times in the
waiting room because clerical monitoring did not occur.
ll. Patient Safety (critical element)
1. Without exception, reviews demographic information provided
and uses two approved
forms of identification to assure patient
being processed
is the same patient
for whom the
request was made
2. Communicates closely with technologists and/or physicians
to assure all understand
nature of request and patient
identity.
Fully Successful: No more than one instance during the appraisal year where a patient was
not correctly identified or incorrect patient
identification was provided
to the technologist.
il-eL:l F rr rl
SECTION A
-
PERFORMANCE PLAN (Continued).
PERFORMANCE ELEMENTS/STANDARDS
lll. Customer Service (critical element)
1. Greets patient with a friendly smile and a helpful manner at all times, and displays a desire to
serye the needs of the patient and/or visitor.
2. Assumes responsibility for patients receiving the information and/or care they request by
personally assuring patients are in contact with the appropriate medical center staff or area.
3. Never engages in confrontational behavior, even with difficult patients.
Employs established
procedures for dealing with difficult patients when unable to resolve an issue.
Fully Successful: No more than 2 instances during the appraisal year when it is determined by the
supervisor that the departmental and/or medical center customer service standards were not
appropriately met.
Age Specific Competency
1. ldentify patient, communicate in a respectful manner, pay attention to and accommodate
individual's physical or mental limitations.
2. Recognize gende4r and cultural differences to determine special needs and provide specific
guidance and assistance to address these needs.
Fully Successful: No more then 2 instances during the appraisal period where the supervisor has
determined that the performance
of assigned duties was conducted in a manner that failed to respec+
or address the special needs of our patients.
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SECTION A
-
PERFORMANCE PLAN (Continued)
PERFORMANCE ELEMENTS/STANDARDS
CHANGES TO PERFORMANCE PLAN (Changes
mqt be recorded unytime during the ruting period)
ELEMENT DESCRIPTION/TITLE
STAI.JDARD(S)
ELEMENT DESCRIPTION/TITLE
STANDARD(S)
SIGNATURE OF RATER DATE SIGNATURE OF EMPLOYEE DATE
At lcust ()nc progrcss rcr icu is rcquircrl tlurin*
pcrtirrrttance plirn.,Atltli tional prrgrcs: rcr, ic* s
SECTION B. PROGRESS REVIEW
thc eppraisul ycar. Ernplo.,'cc rnust hc inlitnnccl
rttit) be tlocuntcntc(i ()n px.gc 6.
of Iris, hcr pl'()grcss lrs ntcasurcrl uglinst tlrc
,\ pertirnt.urncc lcr ic'"v rr'as o()n(luctcd lrrtl rliscus:ctl. .rncl thc
ft
t..,,,1.i.l.r'utl Ftllir Sttecr'silul .t hellct.
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SECTION C
.
ACTUAL ACHIEVEMENT
lndicate the single. overall ler,el o['achicrcrnent that best dcscribes the enrplolce's pertbrlrancc firreach ELEMENT shorrn in Section A. Do nol
indicalc achierelnent tor each individual standard. Specific examples of perlbrmance rnust be provitled in lhe space below lbr each eleprcnl *here
a lcrcl ol'tlchic\enrent otlrer than Fulll Successful has been assigned. ,\ssignment of the !lxceptional leyel means that Fully Successlll
performancc standards have been significantly surpassed.'l'his lerel is reserlcd for emplol,ees nhose performancc in the element lar
erceetls normal erpectations and results in ma.ior contrihutions to the accomplishment of organizational goals.
ELEMENTS
(Use the snme key word ilescriptiottfor ench ele,rret t os in Section
.t)
LEVELS OF ACHIEVEMENT
EXCEPTIONAL
FULLY
SUCCESSFUL
LE55 I IIAN
FULLY
SUCGESSFUL
Patient Processing and Scheduling E tr D
Patient Safety (crit.ical)
a tr tr
Customer Service (critical)
tr D n
Age Specific Competency tr tr n
n tr tr
tr tr n
tr tr tr
Describe specific eratrples ofpertbrnlance filr each element w'here a level o1-achievement other than I'ull) successful has been assigned above.
Specilic achievenrents at the Fully Successl'ul level may be described.
ELEMENTS/ACHIEVEMENT(S)
Mr. Mitchell has been able to work on our backlog of patients and is assisting in the
reduction of the backlog. Mr. Mj-tchel} has work hard and. put in overtime to work on
this situation- He is now engaged in working on a committee to redesign the system to
hopefully reduce our poor wait times.
Mr. Mitchell is concerned about the patient.s and the wo,rkplace environment. He applies
proper processing of patients enterj-ng for their appointments. He has taken special
care of patient.s with problems and assists as need.ed to go beyond his duties within the
clinic such as working on lodging issues etc.
Mr. Mitchell has great
to those patients with
Mr. Mitchell assisted
stored Imaging items.
customer service with his patients and has been especially kind
special needs and issues.
with the cleani-ng of a hazardous area in buildi-ng 500 which
He was given a special contribution award for his efforts.
VA FORM O75O NOV 2OO3
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SECTION D - OVERALL RATING
TYPE OF RATING:
E RruT.IunL RATING OF RECORD E SPECIAL RATING OF RECORD n
SUIVIi,4ARY RATING
(POSITION
CHANGES
_
EMPLOYEE OR RATER
PERIOD COVERED BY THIS APPRAISAL:
NOTE: Recommended Perlbrmance Rating - Using achievernent lcvcls assigned in Scction C and tlre critcria clcsclibccl belorv. chcck
the appropriate rating.
PERFORMANCE RATING
E OUfSf.,tNDING - Achievenrcnt lcvels lirf all clerrents are designated as Exccptional.
' Frlly Sucecsstul. Sorne. but not all. non-critical clernents rnay be designated as Exceptional.
critical c'lenrents ale tlesignatcd as at least Fully Succcssful or higher.
onc (or nrore) noncritical clerrlcnts is (are) dcsignatccl as Less Than Fully Successlul.
E UNSTtfISFACTORY-Theachicvenrentlevel(s)ol'one(ormorc) critical elerirents(s) rs(are) clesignatedasLessThanFullySuccesslul.
SIGNATURE AND TITLE OF RATER DATE
SECTION E. HIGHER LEVEL REVIEWAPPROVAL
tirr Outstancling ratings of rccord.
State the rating to be relerred to the Perfbrmance Review Board if based on consideration of rnultiple summary ratings or if the rater
.'l'ho
supervised an executive tbr less than 90 da.vs endorses the summary rating level proposed by the prc:vious supervisor.
tr
T
Conc ur \\/ith reconlmended rating.
Do not coucu!: with rating. Appror.e rating ol SELEC-[
BASIS FOR PERFORMANCE RATING CHANGE
SIGNATURE AND TITLE OF APPROVAL OFFICIAL
1 /-/..-;-r,
DATE
r\ copy of this perfbnllance appraisal \\'as siven to nre.
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vA FORN.1 ar75u. NOV 20(lii l<eachl-orn]
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