U.S. DEPARTMENT OF THE INTERIOR

**Employee Performance Appraisal Plan**

  ---------------------------- ----------- --------------------- -------------- --------------
  Employee Name and Social                 Title/Series/Grade:                  
  Security Number:                                                              

  Duty Station:                Appraisal                         From:          To:
                               Period:                                          
  ---------------------------- ----------- --------------------- -------------- --------------

**Part A-1: Notification of Standards:** *Signatures certify that
critical elements/standards were discussed.(Part E)*

  ----------------------- ----------------------- -----------------------
  Employee:               Rating Official:        Reviewing Official (if
                                                  applicable\*):

  Date:                   Date:                   Date:
  ----------------------- ----------------------- -----------------------

**Part A-2: Employee Input into Development of Standards:** *Signatures
certify employee involvement was solicited by supervisor:*

  ----------------------- ----------- ----------------------- -----------
  Employee:               Date:       Rating Official:        Date:

  ----------------------- ----------- ----------------------- -----------

**Part A-3: Employee Training:** *Signatures certify employee was
provided training in Performance Management System.*

  ----------------------- ----------- ----------------------- -----------
  Employee:               Date:       Rating Official:        Date:

  ----------------------- ----------- ----------------------- -----------

***Part B: Progress Review:** Signatures certify that performance was
discussed*.

  ----------------------- ----------- ----------------------- -----------
  Employee:               Date:       Rating Official:        Date:

  ----------------------- ----------- ----------------------- -----------

**Part C: Summary Rating Determination:** Assign the numerical rating
level that accurately reflects the employee's performance for each of
the critical elements (Use only whole numbers: **Exceptional = 5 points;
Superior = 4 points, Fully Successful = 3 points, Minimally Successful =
2 points, and Unsatisfactory = 0 points.**) *See reverse for complete
instructions.*

  ----------------------------------- ------------- --------------------------
  **Element Number**                  **Numerical   
                                      Rating**      

  **1**                                             

  **2**                                             

  **3**                                             

  **4**                                             

  **5**                                             

                                      **Total:**    
  ----------------------------------- ------------- --------------------------

  -------------- ----- ------- -------------- ------- ------- ---------------- ------
  **Total              **÷**   **Number of            **=**   **Numeric        
  Numerical                    Elements**                     Summary Rating** 
  Rating**                                                                     

  -------------- ----- ------- -------------- ------- ------- ---------------- ------

**Part D: Summary Rating: Use conversion chart to determine rating.
Check appropriate box:**

+---+----------------+---+-----------------------+-----------------------+
|   | ## Exceptional | 4 |                       |                       |
|   |                | . |                       |                       |
|   |                | 6 |                       |                       |
|   |                | - |                       |                       |
|   |                | - |                       |                       |
|   |                | 5 |                       |                       |
|   |                | . |                       |                       |
|   |                | 0 |                       |                       |
|   |                | 0 |                       |                       |
|   |                | A |                       |                       |
|   |                | N |                       |                       |
|   |                | D |                       |                       |
|   |                | N |                       |                       |
|   |                | o |                       |                       |
|   |                | c |                       |                       |
|   |                | r |                       |                       |
|   |                | i |                       |                       |
|   |                | t |                       |                       |
|   |                | i |                       |                       |
|   |                | c |                       |                       |
|   |                | a |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | m |                       |                       |
|   |                | e |                       |                       |
|   |                | n |                       |                       |
|   |                | t |                       |                       |
|   |                | r |                       |                       |
|   |                | a |                       |                       |
|   |                | t |                       |                       |
|   |                | e |                       |                       |
|   |                | d |                       |                       |
|   |                | l |                       |                       |
|   |                | o |                       |                       |
|   |                | w |                       |                       |
|   |                | e |                       |                       |
|   |                | r |                       |                       |
|   |                | t |                       |                       |
|   |                | h |                       |                       |
|   |                | a |                       |                       |
|   |                | n |                       |                       |
|   |                | " |                       |                       |
|   |                | S |                       |                       |
|   |                | u |                       |                       |
|   |                | p |                       |                       |
|   |                | e |                       |                       |
|   |                | r |                       |                       |
|   |                | i |                       |                       |
|   |                | o |                       |                       |
|   |                | r |                       |                       |
|   |                | " |                       |                       |
|   |                | . |                       |                       |
+---+----------------+---+-----------------------+-----------------------+
|   | **Superior**   | 3 |                       |                       |
|   |                | . |                       |                       |
|   |                | 6 |                       |                       |
|   |                | - |                       |                       |
|   |                | - |                       |                       |
|   |                | 4 |                       |                       |
|   |                | . |                       |                       |
|   |                | 5 |                       |                       |
|   |                | 9 |                       |                       |
|   |                | A |                       |                       |
|   |                | N |                       |                       |
|   |                | D |                       |                       |
|   |                | N |                       |                       |
|   |                | o |                       |                       |
|   |                | c |                       |                       |
|   |                | r |                       |                       |
|   |                | i |                       |                       |
|   |                | t |                       |                       |
|   |                | i |                       |                       |
|   |                | c |                       |                       |
|   |                | a |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | m |                       |                       |
|   |                | e |                       |                       |
|   |                | n |                       |                       |
|   |                | t |                       |                       |
|   |                | r |                       |                       |
|   |                | a |                       |                       |
|   |                | t |                       |                       |
|   |                | e |                       |                       |
|   |                | d |                       |                       |
|   |                | l |                       |                       |
|   |                | o |                       |                       |
|   |                | w |                       |                       |
|   |                | e |                       |                       |
|   |                | r |                       |                       |
|   |                | t |                       |                       |
|   |                | h |                       |                       |
|   |                | a |                       |                       |
|   |                | n |                       |                       |
|   |                | " |                       |                       |
|   |                | F |                       |                       |
|   |                | u |                       |                       |
|   |                | l |                       |                       |
|   |                | l |                       |                       |
|   |                | y |                       |                       |
|   |                | S |                       |                       |
|   |                | u |                       |                       |
|   |                | c |                       |                       |
|   |                | c |                       |                       |
|   |                | e |                       |                       |
|   |                | s |                       |                       |
|   |                | s |                       |                       |
|   |                | f |                       |                       |
|   |                | u |                       |                       |
|   |                | l |                       |                       |
|   |                | " |                       |                       |
|   |                | . |                       |                       |
+---+----------------+---+-----------------------+-----------------------+
|   | **Fully        | 3 |                       |                       |
|   | Successful**   | . |                       |                       |
|   |                | 0 |                       |                       |
|   |                | - |                       |                       |
|   |                | - |                       |                       |
|   |                | 3 |                       |                       |
|   |                | . |                       |                       |
|   |                | 5 |                       |                       |
|   |                | 9 |                       |                       |
|   |                | A |                       |                       |
|   |                | N |                       |                       |
|   |                | D |                       |                       |
|   |                | N |                       |                       |
|   |                | o |                       |                       |
|   |                | c |                       |                       |
|   |                | r |                       |                       |
|   |                | i |                       |                       |
|   |                | t |                       |                       |
|   |                | i |                       |                       |
|   |                | c |                       |                       |
|   |                | a |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | m |                       |                       |
|   |                | e |                       |                       |
|   |                | n |                       |                       |
|   |                | t |                       |                       |
|   |                | r |                       |                       |
|   |                | a |                       |                       |
|   |                | t |                       |                       |
|   |                | e |                       |                       |
|   |                | d |                       |                       |
|   |                | l |                       |                       |
|   |                | o |                       |                       |
|   |                | w |                       |                       |
|   |                | e |                       |                       |
|   |                | r |                       |                       |
|   |                | t |                       |                       |
|   |                | h |                       |                       |
|   |                | a |                       |                       |
|   |                | n |                       |                       |
|   |                | " |                       |                       |
|   |                | F |                       |                       |
|   |                | u |                       |                       |
|   |                | l |                       |                       |
|   |                | l |                       |                       |
|   |                | y |                       |                       |
|   |                | S |                       |                       |
|   |                | u |                       |                       |
|   |                | c |                       |                       |
|   |                | c |                       |                       |
|   |                | e |                       |                       |
|   |                | s |                       |                       |
|   |                | s |                       |                       |
|   |                | f |                       |                       |
|   |                | u |                       |                       |
|   |                | l |                       |                       |
|   |                | " |                       |                       |
|   |                | . |                       |                       |
+---+----------------+---+-----------------------+-----------------------+
|   | **Minimally    | 2 |                       |                       |
|   | Successful**   | . |                       |                       |
|   |                | 0 |                       |                       |
|   |                | - |                       |                       |
|   |                | - |                       |                       |
|   |                | 2 |                       |                       |
|   |                | . |                       |                       |
|   |                | 9 |                       |                       |
|   |                | 9 |                       |                       |
|   |                | A |                       |                       |
|   |                | N |                       |                       |
|   |                | D |                       |                       |
|   |                | N |                       |                       |
|   |                | o |                       |                       |
|   |                | c |                       |                       |
|   |                | r |                       |                       |
|   |                | i |                       |                       |
|   |                | t |                       |                       |
|   |                | i |                       |                       |
|   |                | c |                       |                       |
|   |                | a |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | m |                       |                       |
|   |                | e |                       |                       |
|   |                | n |                       |                       |
|   |                | t |                       |                       |
|   |                | r |                       |                       |
|   |                | a |                       |                       |
|   |                | t |                       |                       |
|   |                | e |                       |                       |
|   |                | d |                       |                       |
|   |                | l |                       |                       |
|   |                | o |                       |                       |
|   |                | w |                       |                       |
|   |                | e |                       |                       |
|   |                | r |                       |                       |
|   |                | t |                       |                       |
|   |                | h |                       |                       |
|   |                | a |                       |                       |
|   |                | n |                       |                       |
|   |                | " |                       |                       |
|   |                | M |                       |                       |
|   |                | i |                       |                       |
|   |                | n |                       |                       |
|   |                | i |                       |                       |
|   |                | m |                       |                       |
|   |                | a |                       |                       |
|   |                | l |                       |                       |
|   |                | l |                       |                       |
|   |                | y |                       |                       |
|   |                | S |                       |                       |
|   |                | u |                       |                       |
|   |                | c |                       |                       |
|   |                | c |                       |                       |
|   |                | e |                       |                       |
|   |                | s |                       |                       |
|   |                | s |                       |                       |
|   |                | f |                       |                       |
|   |                | u |                       |                       |
|   |                | l |                       |                       |
|   |                | " |                       |                       |
|   |                | . |                       |                       |
+---+----------------+---+-----------------------+-----------------------+
|   | **Un           | O |                       |                       |
|   | satisfactory** | n |                       |                       |
|   |                | e |                       |                       |
|   |                | o |                       |                       |
|   |                | r |                       |                       |
|   |                | m |                       |                       |
|   |                | o |                       |                       |
|   |                | r |                       |                       |
|   |                | e |                       |                       |
|   |                | c |                       |                       |
|   |                | r |                       |                       |
|   |                | i |                       |                       |
|   |                | t |                       |                       |
|   |                | i |                       |                       |
|   |                | c |                       |                       |
|   |                | a |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | l |                       |                       |
|   |                | e |                       |                       |
|   |                | m |                       |                       |
|   |                | e |                       |                       |
|   |                | n |                       |                       |
|   |                | t |                       |                       |
|   |                | s |                       |                       |
|   |                | r |                       |                       |
|   |                | a |                       |                       |
|   |                | t |                       |                       |
|   |                | e |                       |                       |
|   |                | d |                       |                       |
|   |                | " |                       |                       |
|   |                | U |                       |                       |
|   |                | n |                       |                       |
|   |                | s |                       |                       |
|   |                | a |                       |                       |
|   |                | t |                       |                       |
|   |                | i |                       |                       |
|   |                | s |                       |                       |
|   |                | f |                       |                       |
|   |                | a |                       |                       |
|   |                | c |                       |                       |
|   |                | t |                       |                       |
|   |                | o |                       |                       |
|   |                | r |                       |                       |
|   |                | y |                       |                       |
|   |                | " |                       |                       |
|   |                | . |                       |                       |
+---+----------------+---+-----------------------+-----------------------+
| E |                |   | Rating Official:      | Reviewing Official:   |
| m |                |   |                       | (if applicable):      |
| p |                |   |                       |                       |
| l |                |   |                       |                       |
| o |                |   |                       |                       |
| y |                |   |                       |                       |
| e |                |   |                       |                       |
| e |                |   |                       |                       |
| : |                |   |                       |                       |
+---+----------------+---+-----------------------+-----------------------+
| D |                |   | Date:                 | Date:                 |
| a |                |   |                       |                       |
| t |                |   |                       |                       |
| e |                |   |                       |                       |
| : |                |   |                       |                       |
+---+----------------+---+-----------------------+-----------------------+

Check here if Interim Rating: \_\_\_\_\_\_

Performance Award: QSI \_\_\_\_ Cash: \$ \_\_\_\_\_\_\_\_ or \_\_\_\_\_%
of pay Time Off \_\_\_\_\_\_

### Instructions for Completing the Employee Performance Appraisal Plan

### Establishing Critical Elements and Performance Standards

Critical elements (at least one, but no more than five) must be
established for each employee at the start of the performance year.
Through these elements, employees are held accountable for work
assignments and responsibilities of their position. A critical element
is an assignment or responsibility of such importance that
Unsatisfactory performance in that element alone would result in a
determination that the employee's overall performance is Unsatisfactory.
Please see the Performance Appraisal Handbook for more detailed
information.

Performance standards are expressions of the performance threshold(s),
requirement(s), or expectation(s) that must be met for each element at a
particular level of performance. They must be focused on results and
include credible measures. You may use the attached Benchmark
Performance Standards to describe general parameters of the standards,
but must augment those benchmarks with specific, measurable criteria
such as quality, quantity, timeliness and/or cost effectiveness, for the
"Fully Successful" level for each element. Rating officials are strongly
encouraged to develop specific performance standards at additional
levels to ensure that the employee has a clear understanding of the
levels of performance expected. *At least one, and preferably all,
critical elements must show how the element is linked to strategic
goals, such as Government Performance Results Act (GPRA) or mission
related goals of the organization.* *These goals should be aligned
throughout the organization (i.e., show how the strategic goal cascades
from the SES down to the lowest non-supervisory levels.) The employee
should be able to clearly understand how the results they are held
responsible for are linked to the results that those in their
supervisory/managerial chain are held responsible for.*

**Employee Involvement**: Employees must be involved in the development
of their performance plans. Part A-2 of this form requires employee and
supervisor signatures certifying that employee input into the
development of the plan was solicited.

## Progress Reviews

A progress review is required approximately mid-way through the rating
period. Part B should be completed after the progress review. Any
written feedback or recommended training can be noted on a separate
sheet and attached to the employee performance appraisal plan.

### Assigning the Summary Rating

A specific rating is required for each critical element to reflect the
level of performance demonstrated by the employee throughout the rating
period. Only one numerical rating level is assigned for each critical
element. Before the rating official assigns a summary rating, he/she
should consider all interim summary ratings received for the employee
during the annual appraisal period. The summary rating is assigned as
follows:

A.  Assess how the employee performed relative to the described
    performance standards.

B.  Document the employee's performance with a narrative that describes
    the achievements for the critical elements as compared to the
    performance standards. A narrative must be written for each critical
    element assigned a rating of Exceptional, Minimally Successful, or
    Unsatisfactory, to provide examples of the employee's performance
    that substantiate and explain how the performance falls within the
    level assigned. There is a block provided for the narrative for each
    critical element.

C.  In Part C of this form, assign one of the numerical rating levels
    that accurately reflects the employee's performance for each of the
    critical elements (Use only whole numbers: Exceptional = 5 points,
    Superior= 4 points, Fully Successful = 3 points, Minimally
    Successful = 2 points, and Unsatisfactory = 0 points).

D.  Add up the numerical rating levels to get a total, and then divide
    the total by the number of critical elements to get an average.
    (Elements that are "not rated" because an employee has not had a
    chance to perform them during the rating year are not assigned any
    points and should not be used to determine the average rating.)

E.  Assign a summary rating based on the table in Part D of this form.
    Employee and supervisor sign the form certifying that the rating was
    discussed. Reviewing Official's signature is required for
    Exceptional, Minimally Successful and Unsatisfactory ratings.

**Note:** Whenever an employee is rated **"Unsatisfactory"** on one or
more critical elements, the overall rating **must** be
**"Unsatisfactory"** (regardless of total points). **The rating official
should immediately contact the servicing human resources office.**
Whenever an employee is rated **"Minimally Successful"** on one or more
critical elements, the overall rating may not be higher than
**"Minimally Successful"** (regardless of total points).

***Part E: Critical Elements and Performance Standards: List below each
of the employee's critical elements (at least one, but no more than 5)
and their corresponding performance standards. If Benchmark Standards
are used, indicate "Benchmark Standards are attached" in the space
below, and ensure they are attached to this form. Identify the
GPRA/strategic/mission goal that the critical element supports. At a
minimum, measurable criteria must be identified at the Fully Successful
level.***

+-----------------+-----------------------------------------------------+
| **Critical      | **GPRA/Strategic Goal**:                            |
| Element 1:**    |                                                     |
|                 | **Performance Measure:**                            |
+-----------------+-----------------------------------------------------+
| ##### Perfor    |                                                     |
| mance Standards |                                                     |
+-----------------+-----------------------------------------------------+
| ## Exceptional  | See Benchmark Standards attached.                   |
+-----------------+-----------------------------------------------------+
| **Superior**    | See Benchmark Standards attached.                   |
+-----------------+-----------------------------------------------------+
| **Fully         | In additional to attached benchmark standards, the  |
| Successful**    | following measurable criteria apply.                |
+-----------------+-----------------------------------------------------+
| **Minimally     | See Benchmark Standards attached.                   |
| Successful**    |                                                     |
+-----------------+-----------------------------------------------------+
| **U             | See Benchmark Standards attached.                   |
| nsatisfactory** |                                                     |
+-----------------+-----------------------------------------------------+
| ##### Na        |                                                     |
| rrative Summary |                                                     |
+-----------------+-----------------------------------------------------+
| Describe the    |                                                     |
| employee's      |                                                     |
| performance for |                                                     |
| each critical   |                                                     |
| element. A      |                                                     |
| narrative       |                                                     |
| summary must be |                                                     |
| written for     |                                                     |
| each element    |                                                     |
| assigned a      |                                                     |
| rating of       |                                                     |
| Exceptional,    |                                                     |
| Minimally       |                                                     |
| Successful, or  |                                                     |
| Unsatisfactory. |                                                     |
+-----------------+-----------------------------------------------------+
| **Rating for    |                                                     |
| Critical        |                                                     |
| Element 1:**    |                                                     |
|                 |                                                     |
| **\[ \]         |                                                     |
| Exceptional-5   |                                                     |
| \[ \]           |                                                     |
| Superior-4 \[   |                                                     |
| \] Fully        |                                                     |
| Successful-3 \[ |                                                     |
| \] Minimally    |                                                     |
| Successful-2 \[ |                                                     |
| \]              |                                                     |
| Uns             |                                                     |
| atisfactory-0** |                                                     |
+-----------------+-----------------------------------------------------+

***Part E: Critical Elements and Performance Standards:** List below
each of the employee's critical elements (at least one, but no more than
5) and their corresponding performance standards. If Benchmark Standards
are used, indicate "Benchmark Standards are attached" in the space
below, and ensure they are attached to this form. Identify the
GPRA/strategic/mission goal that the critical element supports. At a
minimum, measurable criteria must be identified at the Fully Successful
level.*

+-----------------+-----------------------------------------------------+
| **Critical      | **GPRA/Strategic Goal**:                            |
| Element 2:**    |                                                     |
|                 | **Performance Measure:**                            |
+-----------------+-----------------------------------------------------+
| ##### Perfor    |                                                     |
| mance Standards |                                                     |
+-----------------+-----------------------------------------------------+
| ## Exceptional  | See Benchmark Standards attached.                   |
+-----------------+-----------------------------------------------------+
| **Superior**    | See Benchmark Standards attached                    |
+-----------------+-----------------------------------------------------+
| **Fully         | In additional to attached benchmark standards, the  |
| Successful**    | following measurable criteria apply.                |
+-----------------+-----------------------------------------------------+
| **Minimally     | See Benchmark standards attached                    |
| Successful**    |                                                     |
+-----------------+-----------------------------------------------------+
| **U             | See Benchmark standards attached                    |
| nsatisfactory** |                                                     |
+-----------------+-----------------------------------------------------+
| ##### Na        |                                                     |
| rrative Summary |                                                     |
+-----------------+-----------------------------------------------------+
| Describe the    |                                                     |
| employee's      |                                                     |
| performance for |                                                     |
| each critical   |                                                     |
| element. A      |                                                     |
| narrative       |                                                     |
| summary must be |                                                     |
| written for     |                                                     |
| each element    |                                                     |
| assigned a      |                                                     |
| rating of       |                                                     |
| Exceptional,    |                                                     |
| Minimally       |                                                     |
| Successful, or  |                                                     |
| Unsatisfactory. |                                                     |
+-----------------+-----------------------------------------------------+
| **Rating for    |                                                     |
| Critical        |                                                     |
| Element 2:**    |                                                     |
|                 |                                                     |
| **\[ \]         |                                                     |
| Exceptional-5   |                                                     |
| \[ \]           |                                                     |
| Superior-4 \[   |                                                     |
| \] Fully        |                                                     |
| Successful-3 \[ |                                                     |
| \] Minimally    |                                                     |
| Successful-2 \[ |                                                     |
| \]              |                                                     |
| Uns             |                                                     |
| atisfactory-0** |                                                     |
+-----------------+-----------------------------------------------------+

***Part E: Critical Elements and Performance Standards:** List below
each of the employee's critical elements (at least one, but no more than
5) and their corresponding performance standards. If Benchmark Standards
are used, indicate "Benchmark Standards are attached" in the space
below, and ensure they are attached to this form. Identify the
GPRA/strategic/mission goal that the critical element supports. At a
minimum, measurable criteria must be identified at the Fully Successful
level.*

+-----------------+-----------------------------------------------------+
| **Critical      | **GPRA/Strategic Goal**:                            |
| Element 3:**    |                                                     |
|                 | **Performance Measure:**                            |
+-----------------+-----------------------------------------------------+
| ##### Perfor    |                                                     |
| mance Standards |                                                     |
+-----------------+-----------------------------------------------------+
| ## Exceptional  | See Benchmark Standards attached.                   |
+-----------------+-----------------------------------------------------+
| **Superior**    | See Benchmark standards attached                    |
+-----------------+-----------------------------------------------------+
| **Fully         | In additional to attached benchmark standards, the  |
| Successful**    | following measurable criteria apply.                |
|                 |                                                     |
|                 | .                                                   |
+-----------------+-----------------------------------------------------+
| **Minimally     | See Benchmark standards attached                    |
| Successful**    |                                                     |
+-----------------+-----------------------------------------------------+
| **U             | See Benchmark standards attached                    |
| nsatisfactory** |                                                     |
+-----------------+-----------------------------------------------------+
| ##### Na        |                                                     |
| rrative Summary |                                                     |
+-----------------+-----------------------------------------------------+
| Describe the    |                                                     |
| employee's      |                                                     |
| performance for |                                                     |
| each critical   |                                                     |
| element. A      |                                                     |
| narrative       |                                                     |
| summary must be |                                                     |
| written for     |                                                     |
| each element    |                                                     |
| assigned a      |                                                     |
| rating of       |                                                     |
| Exceptional,    |                                                     |
| Minimally       |                                                     |
| Successful, or  |                                                     |
| Unsatisfactory. |                                                     |
+-----------------+-----------------------------------------------------+
| **Rating for    |                                                     |
| Critical        |                                                     |
| Element 3:**    |                                                     |
|                 |                                                     |
| **\[ \]         |                                                     |
| Exceptional-5   |                                                     |
| \[ \]           |                                                     |
| Superior-4 \[   |                                                     |
| \] Fully        |                                                     |
| Successful-3 \[ |                                                     |
| \] Minimally    |                                                     |
| Successful-2 \[ |                                                     |
| \]              |                                                     |
| Uns             |                                                     |
| atisfactory-0** |                                                     |
+-----------------+-----------------------------------------------------+

***Part E: Critical Elements and Performance Standards:** List below
each of the employee's critical elements (at least one, but no more than
5) and their corresponding performance standards. If Benchmark Standards
are used, indicate "Benchmark Standards are attached" in the space
below, and ensure they are attached to this form. Identify the
GPRA/strategic/mission goal that the critical element supports. At a
minimum, measurable criteria must be identified at the Fully Successful
level.*

+-----------------+-----------------------------------------------------+
| **Critical      | **GPRA/Strategic Goal**:                            |
| Element 4:**    |                                                     |
|                 | **Performance Measure:**                            |
+-----------------+-----------------------------------------------------+
| ##### Perfor    |                                                     |
| mance Standards |                                                     |
+-----------------+-----------------------------------------------------+
| ## Exceptional  | See Benchmark Standards attached.                   |
+-----------------+-----------------------------------------------------+
| **Superior**    | See Benchmark standards attached                    |
+-----------------+-----------------------------------------------------+
| **Fully         | In additional to attached benchmark standards, the  |
| Successful**    | following measurable criteria apply.                |
+-----------------+-----------------------------------------------------+
| **Minimally     | See Benchmark standards attached                    |
| Successful**    |                                                     |
+-----------------+-----------------------------------------------------+
| **U             | See Benchmark standards attached                    |
| nsatisfactory** |                                                     |
+-----------------+-----------------------------------------------------+
| ##### Na        |                                                     |
| rrative Summary |                                                     |
+-----------------+-----------------------------------------------------+
| Describe the    |                                                     |
| employee's      |                                                     |
| performance for |                                                     |
| each critical   |                                                     |
| element. A      |                                                     |
| narrative       |                                                     |
| summary must be |                                                     |
| written for     |                                                     |
| each element    |                                                     |
| assigned a      |                                                     |
| rating of       |                                                     |
| Exceptional,    |                                                     |
| Minimally       |                                                     |
| Successful, or  |                                                     |
| Unsatisfactory. |                                                     |
+-----------------+-----------------------------------------------------+
| **Rating for    |                                                     |
| Critical        |                                                     |
| Element 4:**    |                                                     |
|                 |                                                     |
| **\[ \]         |                                                     |
| Exceptional-5   |                                                     |
| \[ \]           |                                                     |
| Superior-4 \[   |                                                     |
| \] Fully        |                                                     |
| Successful-3 \[ |                                                     |
| \] Minimally    |                                                     |
| Successful-2 \[ |                                                     |
| \]              |                                                     |
| Uns             |                                                     |
| atisfactory-0** |                                                     |
+-----------------+-----------------------------------------------------+

***Part E: Critical Elements and Performance Standards:** List below
each of the employee's critical elements (at least one, but no more than
5) and their corresponding performance standards. If Benchmark Standards
are used, indicate "Benchmark Standards are attached" in the space
below, and ensure they are attached to this form. Identify the
GPRA/strategic/mission goal that the critical element supports. At a
minimum, measurable criteria must be identified at the Fully Successful
level.*

+-----------------+-----------------------------------------------------+
| **Critical      | **GPRA/Strategic Goal**:                            |
| Element 5:**    |                                                     |
|                 | **Performance Measure:**                            |
+-----------------+-----------------------------------------------------+
| ##### Perfor    |                                                     |
| mance Standards |                                                     |
+-----------------+-----------------------------------------------------+
| ## Exceptional  | See Benchmark Standards attached.                   |
+-----------------+-----------------------------------------------------+
| **Superior**    | See Benchmark standards attached                    |
+-----------------+-----------------------------------------------------+
| **Fully         | In additional to attached benchmark standards, the  |
| Successful**    | following measurable criteria apply.                |
+-----------------+-----------------------------------------------------+
| **Minimally     | See Benchmark standards attached                    |
| Successful**    |                                                     |
+-----------------+-----------------------------------------------------+
| **U             | See Benchmark standards attached                    |
| nsatisfactory** |                                                     |
+-----------------+-----------------------------------------------------+
| ##### Na        |                                                     |
| rrative Summary |                                                     |
+-----------------+-----------------------------------------------------+
| Describe the    |                                                     |
| employee's      |                                                     |
| performance for |                                                     |
| each critical   |                                                     |
| element. A      |                                                     |
| narrative       |                                                     |
| summary must be |                                                     |
| written for     |                                                     |
| each element    |                                                     |
| assigned a      |                                                     |
| rating of       |                                                     |
| Exceptional,    |                                                     |
| Minimally       |                                                     |
| Successful, or  |                                                     |
| Unsatisfactory. |                                                     |
+-----------------+-----------------------------------------------------+
| **Rating for    |                                                     |
| Critical        |                                                     |
| Element 5:**    |                                                     |
|                 |                                                     |
| **\[ \]         |                                                     |
| Exceptional-5   |                                                     |
| \[ \]           |                                                     |
| Superior-4 \[   |                                                     |
| \] Fully        |                                                     |
| Successful-3 \[ |                                                     |
| \] Minimally    |                                                     |
| Successful-2 \[ |                                                     |
| \]              |                                                     |
| Uns             |                                                     |
| atisfactory-0** |                                                     |
+-----------------+-----------------------------------------------------+

**Privacy Act Notice:** Chapter 43 of Title 5, U.S.C., authorizes
collection of this information. The primary use of this information is
by management and your servicing human resources office to issue and
record your performance rating. Additional disclosures of this
information may be: To MSPB, Office of Special Counsel, EEOC, the FLRA,
or an arbitrator in connection with administrative proceedings; to the
Department of Justice or other Federal agency, courts, or party to
litigation when the Government is a party to or has an interest in the
judicial or administrative proceeding; to a congressional office in
response to an inquiry made on behalf of an individual; to the
appropriate Federal, State, or local government agency investigating
potential violations of civil or criminal law or regulation; and to
Federal State, local and professional licensing boards in determining
qualifications of individuals seeking to be licensed.

Collection of your Social Security Number is authorized by Executive
Order 9397. Furnishing your Social Security Number is mandatory, failure
to provide this information will prohibit data collection required by
the Office of Personnel Management.

If your agency used the information furnished on this form for purposes
other than those indicated above, it may provide you with an additional
statement reflecting those purposes.

**[Benchmark Employee Performance Standards]{.underline}**

**Exceptional:**

Employee demonstrates particularly excellent performance that is of such
high quality that organizational goals have been achieved that would not
have been otherwise. The employee demonstrates mastery of technical
skills and a thorough understanding of the mission of the organization
and has a fundamental impact on the completion of program objectives.

The employee exerts a major positive influence on management practices,
operating procedures and/or program implementation, which contributes
substantially to organizational growth and recognition. The employee
plans for the unexpected and uses alternate ways of reaching goals.
Difficult assignments are handled intelligently and effectively. The
employee has produced an exceptional quantity of work, often ahead of
established schedules and with little supervision.

The employee's oral and written communications are exceptionally clear
and effective. He/she improves cooperation among participants in the
workplace and prevents misunderstandings. Complicated or controversial
subjects are presented or explained effectively to a variety of
audiences so that desired outcomes are achieved.

**Superior:**

Employee demonstrates unusually good performance that exceeds
expectations in critical areas and exhibits a sustained support of
organizational goals. The employee shows a comprehensive understanding
of the objectives of the job and the procedures for meeting them.

Effective planning by the employee improves the quality of management
practices, operating procedures, task assignments and/or program
activities. The employee develops and/or implements workable and
cost-effective approaches to meeting organizational goals.

The employee demonstrates an ability to get the job done well in more
than one way while handling difficult and unpredicted problems. The
employee produces a high quantity of work, often ahead of established
schedules with less than normal supervision.

The employee writes and speaks clearly on difficult subjects to a wide
range of audiences and works effectively with others to accomplish
organizational objectives.

Fully Successful:

The employee demonstrates good, sound performance that meets
organizational goals. All critical activities are generally completed in
a timely manner and supervisor is kept informed of work issues,
alterations and status. The employee effectively applies technical
skills and organizational knowledge to get the job done. The employee
successfully carries out regular duties while also handling any
difficult special assignments. The employee plans and performs work
according to organizational priorities and schedules. The employee
communicates clearly and effectively.

Minimally Successful:

The employee's performance shows serious deficiencies that requires
correction. The employee's work frequently needs revision or adjustments
to meet a minimally successful level. All assignments are completed, but
often require assistance from supervisor and/or peers. Organizational
goals and objectives are met only as a result of close supervision. On
one or more occasions, important work requires unusually close
supervision to meet organizational goals or needs so much revision that
deadlines were missed or imperiled.

Employee shows a lack of awareness of policy implications or
assignments; inappropriate or incomplete use of programs or services;
circumvention of established procedures, resulting in unnecessary
expenditure of time or money; reluctance to accept responsibility;
disorganization in carrying out assignments; incomplete understanding of
one or more important areas of the field of work; unreliable methods for
completing assignments; lack of clarity in writing and speaking; and/or
failure to promote team spirit.

Unsatisfactory:

The employee's performance is unsatisfactory. The quality and quantity
of the employee's work are not adequate for the position. Work products
do not meet the minimum requirements expected.

The employee demonstrates little or no contribution to organizational
goals; failure to meet work objectives; inattention to organizational
priorities and administrative requirements; poor work habits resulting
in missed deadlines and/or incomplete work products; strained work
relationships; failure to respond to client needs; and/or lack of
response to supervisor's corrective efforts.

**Understanding Performance Management**

**An Employee's Duties --** Your supervisor should provide you with a
copy of the position description for your job. Your position description
is the official record of your main duties and responsibilities and is
used in developing performance appraisal criteria. Take some time to
read through your position description. Ask your supervisor about
anything that is not clear to you. Your supervisor should review your
position description with you at least once a year to ensure that it
accurately reflects your main duties and responsibilities. Keep a copy
of your position description and refer to it from time to time. You may
want to make notes on your copy when your job changes, so that you can
discuss the changes with your supervisor.

**Employee Performance Appraisal Plan (EPAP)** -- The Employee
Performance Appraisal Plan (EPAP) is the form used by the Department to
evaluate the work performance of its employees under the 5-level
appraisal system. When used effectively, the EPAP is a valuable
communication tool for both employee development and organizational
accomplishments.

Managers and supervisors are responsible for the following:

> 1\. Complying with provisions of the U.S. Department of the
> Interior\'s Performance Appraisal Departmental Manual and Handbook
> (370 DM 430).\
> 2. Establishing performance elements and performance standards that
> are linked to organizational goals and position descriptions.\
> 3. Monitoring employee performance, communicating with employees about
> their performance and resolving performance problems.\
> 4. Approving or reviewing ratings recommended by supervisors or rating
> officials.

The EPAP has several important goals:

1\. Clarifying how the employee's performance requirements link to the
strategic mission of their organization;

> 2\. Increasing individual productivity by giving employees the
> information they need to do their jobs effectively;\
> 3. Improving individual/organizational productivity by promoting
> communication between employees and supervisors about job-related
> matters, so that better and more efficient methods of operation can be
> developed; and,\
> 4. Providing a process to recognize employees for good performance and
> their contributions to the organization.

**Appraisal Period --** The appraisal period begins October 1 and ends
September 30 of each year, except where specific exceptions have been
granted. The minimum period on which an appraisal may be based is 90
calendar days. During the appraisal period, your supervisor may
periodically discuss your work with you and let you know how you are
doing. In addition, before the end of the appraisal period, the
supervisor will conduct one formal progress review with you. This
progress review is another opportunity for you and your supervisor to
discuss your progress, review your position description, identify any
training needs or improvements, or to revise your critical performance
elements and performance standards.

**Performance Elements and Performance Standards --** Your supervisor
will explain your duties and responsibilities to you and discuss what is
expected of you in order to achieve satisfactory performance. To further
define your performance expectations, your supervisor will establish
performance elements and performance standards for your job. Employee
input into this process is required.\
\
Performance elements tell you what work assignments and responsibilities
need to be accomplished during the appraisal period. All employees must
have one performance element that is linked to the strategic mission or
Government Performance Results Act goals of the organization. Between
one and five performance elements can be established for a position.
These elements are all considered critical elements. They are of such
importance to the position that unsatisfactory performance in one
element alone would result in a determination that the employee\'s
overall performance is unsatisfactory.\
\
Performance standards tell employees how well performance elements must
be done by defining achievable rating levels for: Exceptional, Superior,
Fully Successful, Minimally Successful, and Unsatisfactory performance.
These five rating levels focus on results and include credible measures
such as quality, quantity, timeliness, cost effectiveness, etc.\
\
Your overall performance is evaluated by your supervisor or rating
official using these performance standards. A determination that an
employee\'s overall performance is unsatisfactory could result in
remedial action and unsatisfactory performance may be the basis for
removal or reduction in grade. Minimally successful performance may
result in the denial of a within-grade increase.

**The Rating Process --** At the end of the appraisal period, your
supervisor will carefully review the performance elements and standards
for your position. Based on your actual performance, one of five rating
levels may be assigned. The rating will be presented to you during the
formal performance discussion between you and your supervisor. The
appraisal will be completed with your signature and a copy provided to
you. This rating is documented on the EPAP form and is considered as
your Rating of Record. Your rating of record is directly linked to your
eligibility for certain types of pay increases and awards.

**Rewarding Performance --** Rewarding performance means recognizing
good performance and providing incentives to employees for their work
efforts and contributions to the organization. At the end of the
appraisal period, your supervisor may consider you for an award based on
your performance and rating of record as follows:

-   Exceptional -- Eligible for an individual cash award up to 5% of
    base pay; a Quality Step Increase; Time-Off Award; or other
    appropriate equivalent recognition.

-   Superior -- Eligible for an individual cash award up to 3% of base
    pay; Time-Off Award, non-monetary award, or other appropriate
    equivalent recognition.

-   Fully Successful -- Not eligible for any performance award, but may
    receive monetary, non-monetary, Time-off, or other appropriate
    incentive awards for specific accomplishments throughout the year.

-   Minimally Successful and Unsatisfactory -- Ineligible for any
    performance recognition.

**How to get the most out of your Employee Performance Appraisal Plan**

1\. Ask for Feedback throughout the appraisal period.\
\
How do you know if you are learning how to do your job and meeting your
performance expectations? Talk to your supervisor throughout the
appraisal period. Your supervisor wants you to succeed and is available
to provide guidance to help you learn how to effectively do your job.
Communicating regularly with your supervisor gives you the opportunity
to understand the job expectations. It also lets your supervisor know
what type of assistance or resources you need to perform your work, and
it is a good way to get feedback.\
\
Feedback is information that helps you know how you are progressing in
learning the duties and responsibilities of your job. Employees who seek
feedback from their supervisors learn their jobs more quickly and with
fewer wrong turns than employees who shy away from feedback. Employees
who seek feedback spend less time redoing work and turn in work with
fewer mistakes. As a result, they improve their work performance.\
\
Getting and using feedback is one of the most important keys to learning
your job. As you do your work, ask for feedback from your supervisor to
see if you are on track. At first you may feel uncomfortable asking for
feedback. But, remember that your supervisor wants you to succeed. As
you master your job and get to know your supervisor, you will soon feel
more comfortable asking for and receiving feedback.

2\. Preparation

a\. Before your supervisor prepares your appraisal:

> 1\. Prepare a list of key work accomplishments and give it to your
> supervisor for consideration in preparing your rating.\
> 2. If you have specific issues come prepared to discuss them. Give
> your supervisor a \"heads up\" so that they can also prepare to
> discuss the issues.\
> 3. Jot down any key points and questions you may have.

b\. During your performance discussion:

> 1\. Don\'t be shy about asking for clarification, especially about
> your supervisor\'s expectations.\
> 2. Refer to your notes, so that you don\'t overlook any points that
> are important to you.\
> 3. Tell your supervisor how you feel things are progressing and if you
> need any additional information or materials.\
> 4. Let your supervisor know what your short/long-term career goals
> are.\
> 5. Ask for feedback.

If you still have questions about the Employee Performance Appraisal
Plan, stop by and talk to your supervisor, who will be happy to address
any questions you may have.

/media/pszemraj/PeterTrove/project-files/DATA/ms-word-files/big-DOC/167724.doc