Performance Improvement Plan Checklist Form
Please complete the checklist to assess performance improvement areas.
Employee Name
*
First Name
Last Name
Employee ID
*
Department
*
Please Select
Sales
Marketing
Finance
Human Resources
IT
Operations
Customer Service
Administration
Other
Manager Name
*
First Name
Last Name
Date of Plan Initiation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Performance Areas to Improve
*
Specific Goals and Actions
*
Employee Comments
*
Manager Comments
*
Employee Signature
*
Manager Signature
*
Submit
Should be Empty: