Tompkins County Office for the Aging

Individual Performance Achievement Plan/Review     
	 [    ]Initial Review
 [    ]Quarterly Review
 [    ]Yearly Review	
Employee’s Name:_______________________________	Date of Review:_________________________________	
Job Title:_______________________________________	Review Period:   from_____________to______________	
The employee and supervisor agree that the Performance Plan/Review is a fair representation of the employee’s performance for the period noted.	
Goals/Objectives	Review	
Employee Signature:	Date:	Employee Signature:	Date:	
Supervisor Signature:	Date:	Supervisor Signature:	Date:	

Job Results
•	

Goal

	Supporting Objectives

	Actual Results	Comments

	

Personal Development	
Goal	Supporting Objectives	Actual Results	Comments