NO NAME DIALYSIS CENTER PERFORMANCE APPRAISAL ACTION PLAN

Employee Name: Title: Manager’s Name: Location/Department:

The purpose of this action plan is to identify the behavior(s), performance dimension or skill(s) that must be improved or developed to meet position expectations. The following strategies outline opportunities for improvement or development. The expectation is that the manager and employee meet periodically (bi-weekly, monthly) to review progress on action plan components and make necessary changes or revisions as needed.

Dimension Action Timeframe/Completion Identify area, skill, rated Include recommendations Deadline as needs improvement on evaluation. Mary will document the . Uses evidence-based . Completes on 100% of following when assessment primary care patients completing pt. techniques, over the next 90 days assessments.....(take instruments, tools, wording from standard) available data, information, and knowledge relevant to Assessment of the Dialysis the situation to Patient (standard1) identify patterns and . variances The nephrology registered . Adheres to applicable nurse collects pertinent federal, state, and local data and information regulations for relative to the healthcare assessment criteria consumer’s health or the and frequency for situation. healthcare consumers undergoing kidney replacement therapies (KRTs). . Documents relevant data accurately and in a manner accessible to the interprofessional team. . 2.

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Employee Signature: Date:

Manager Signature: Date: