+---+---+----------------------+------------------+-----------+-----------+
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| * |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
| E |   |                      |                  | APPRAISAL |           |
| M |   |                      |                  | PERIOD    |           |
| P |   |                      |                  |           |           |
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| I |   |                      |                  |           |           |
| ) |   |                      |                  |           |           |
| * |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   |                      |                  | From:     | To:       |
|   |   |                      |                  |           |           |
|   |   |                      |                  | 6/30/2006 | 1         |
|   |   |                      |                  |           | 2/31/2006 |
+---+---+----------------------+------------------+-----------+-----------+
| O |   |                      | POSITION TITLE,  |           |           |
| R |   |                      | SERIES, AND      |           |           |
| G |   |                      | GRADE            |           |           |
| A |   |                      |                  |           |           |
| N |   |                      | Research         |           |           |
| I |   |                      | Chemist, GS-1320 |           |           |
| Z |   |                      |                  |           |           |
| A |   |                      |                  |           |           |
| T |   |                      |                  |           |           |
| I |   |                      |                  |           |           |
| O |   |                      |                  |           |           |
| N |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
| * |   |                      |                  |           |           |
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| N |   |                      |                  |           |           |
| D |   |                      |                  |           |           |
| A |   |                      |                  |           |           |
| P |   |                      |                  |           |           |
| P |   |                      |                  |           |           |
| R |   |                      |                  |           |           |
| A |   |                      |                  |           |           |
| I |   |                      |                  |           |           |
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| A |   |                      |                  |           |           |
| L |   |                      |                  |           |           |
| * |   |                      |                  |           |           |
| * |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
| * |   | **Performance Plan   |                  |           |           |
| * |   | Development -**      |                  |           |           |
| A |   | *Establishes Annual  |                  |           |           |
| . |   | Performance          |                  |           |           |
| * |   | Expectations*        |                  |           |           |
| * |   |                      |                  |           |           |
|   |   | \[**NOTE:** The      |                  |           |           |
|   |   | employee\'s          |                  |           |           |
|   |   | signature does not   |                  |           |           |
|   |   | necessarily mean     |                  |           |           |
|   |   | agreement; only that |                  |           |           |
|   |   | the plan has been    |                  |           |           |
|   |   | communicated.\]      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | RATING OFFICIAL\'S   |                  |           | DATE      |
|   |   | SIGNATURE            |                  |           |           |
|   |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | REVIEWING            |                  |           | DATE      |
|   |   | OFFICIAL\'S          |                  |           |           |
|   |   | SIGNATURE *(If       |                  |           |           |
|   |   | required by OPDIV    |                  |           |           |
|   |   | Head)*               |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | EMPLOYEE\'S          |                  |           | DATE      |
|   |   | SIGNATURE            |                  |           |           |
|   |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   | * | **Progress Review    |                  |           |           |
|   | * | -** *Written         |                  |           |           |
|   | B | narrative required   |                  |           |           |
|   | . | if performance on    |                  |           |           |
|   | * | any element is less  |                  |           |           |
|   | * | than Fully           |                  |           |           |
|   |   | Successful.*         |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | RATING OFFICIAL\'S   |                  |           | DATE      |
|   |   | SIGNATURE            |                  |           |           |
|   |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | EMPLOYEE\'S          |                  |           | DATE      |
|   |   | SIGNATURE            |                  |           |           |
|   |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   | * | **Summary Rating -** |                  |           |           |
|   | * | *Section II,         |                  |           |           |
|   | C | Critical Elements,   |                  |           |           |
|   | . | must be completed in |                  |           |           |
|   | * | order to generate    |                  |           |           |
|   | * | this Summary         |                  |           |           |
|   |   | Rating.*             |                  |           |           |
|   |   |                      |                  |           |           |
|   |   | \[**NOTE:** The      |                  |           |           |
|   |   | employee\'s          |                  |           |           |
|   |   | signature does not   |                  |           |           |
|   |   | necessarily mean     |                  |           |           |
|   |   | agreement; only that |                  |           |           |
|   |   | the rating has been  |                  |           |           |
|   |   | communicated.\]      |                  |           |           |
|   |   |                      |                  |           |           |
|   |   | **Exceptional**      |                  |           |           |
|   |   | **Fully Successful** |                  |           |           |
|   |   | **Minimally          |                  |           |           |
|   |   | Successful**         |                  |           |           |
|   |   | **Unacceptable**     |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | RATING OFFICIAL\'S   |                  |           | DATE      |
|   |   | SIGNATURE            |                  |           |           |
|   |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | REVIEWING            |                  |           | DATE      |
|   |   | OFFICIAL\'S          |                  |           |           |
|   |   | SIGNATURE *(If       |                  |           |           |
|   |   | required by OPDIV    |                  |           |           |
|   |   | Head) (Required if   |                  |           |           |
|   |   | rating is            |                  |           |           |
|   |   | Unacceptable)*       |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+
|   |   | EMPLOYEE\'S          |                  |           | DATE      |
|   |   | SIGNATURE            |                  |           |           |
|   |   |                      |                  |           |           |
+---+---+----------------------+------------------+-----------+-----------+

+-----------------------------------------------------------------------+
| **II.** **CRITICAL ELEMENTS**                                         |
|                                                                       |
|   ------------------------------------------------------------------  |
|                                                                       |
|   ***INDIVIDUAL PERFORMANCE OUTCOMES - CRITICAL ELEMENTS              |
|   (continued)***                                                      |
|                                                                       |
|   ------------------------------------------------------------------  |
|                                                                       |
| **The following guidance will be followed in determining an overall   |
| summary rating:**                                                     |
|                                                                       |
| A rating will be assigned to each critical element (Administrative    |
| Requirements (Part A. of this Section) and the individual critical    |
| elements\                                                             |
| under the Individual Performance Outcomes (Part B. of this Section)). |
| This rating will be based upon the extent to which the employee\'s\   |
| performance met one of the \"Performance Standards\" defined in       |
| Section V. (Exceptional, Fully Successful, Minimally Successful, and\ |
| Unacceptable).                                                        |
|                                                                       |
| **The rating level definitions will be assigned a numerical score as  |
| follows:**                                                            |
|                                                                       |
| Exceptional (E): 5 points, Fully Successful (FS): 3 points, Minimally |
| Successful (MS): 2 points, Unacceptable (U): 1 point                  |
|                                                                       |
| **NOTE:** Performance plans must include one or more outcomes\* *that |
| include or track back to the* **\"One HHS\" Program and Management\   |
| Objectives**. This cascading approach should ensure that performance  |
| plans for all employees support the organizational goals of the\      |
| agency. Any \"cascade\" element should be identified in the following |
| way under the appropriate outcome in the performance plan: *\"This\   |
| element also relates to and supports objectives in the \"One HHS\"    |
| Program and Management Objectives, specifically \[cite the specific\  |
| objective\].\"*                                                       |
|                                                                       |
| *\* The outcomes may be **Administrative Requirements** and/or        |
| **Individual Performance**, but at least one outcome must include or  |
| track back to the \"One\                                              |
| HHS\" Program and Management Objectives.*                             |
+-----------------------------------------------------------------------+
| **II.** ***ADMINISTRATIVE REQUIREMENTS - CRITICAL ELEMENT***          |
+-----------------------------------------------------------------------+
| **A. NOTE:** The supervisor should determine, by marking the          |
| appropriate box(es), which aspects of this critical element apply to  |
| the\                                                                  |
| employee\'s job duties and responsibilities.                          |
|                                                                       |
| ####### For Managers/Supervisors & Team Leaders\*\*                   |
+-----------------------------------------------------------------------+
| > Leads in a proactive, customer-responsive manner consistent with    |
| > OPDIV/STAFFDIV vision and values: ascertains\                       |
| > customer needs/requirements; solicits feedback; and makes           |
| > appropriate adjustments.                                            |
| >                                                                     |
| > Communicates program and management goals to staff; identifies      |
| > targeted results/outcomes, and timeframes. Allocates and adjusts    |
| > resources in response to workload and priority changes.             |
| >                                                                     |
| > Plans, organizes, and assigns unit work.                            |
| >                                                                     |
| > Establishes employee performance plans, and completes required      |
| > reviews and final ratings.                                          |
| >                                                                     |
| > Appropriately recognizes and rewards employee performance.          |
| >                                                                     |
| > Assesses employees\' individual developmental needs, and provides   |
| > developmental opportunities to staff.                               |
| >                                                                     |
| > Ensures employee awareness of, and compliance with, requirements    |
| > relative to ethics, financial disclosure, avoiding conflicts of     |
| > interest, standards of ethical conduct, political activity, and     |
| > procurement integrity.                                              |
| >                                                                     |
| > Demonstrates support for EEO/diversity and employee worklife        |
| > quality and fosters a cooperative work environment where diverse    |
| > opinions are solicited and respected.                               |
| >                                                                     |
| > Participates in updating and implementing succession plans for      |
| > current and future staffing needs.                                  |
| >                                                                     |
| > Seeks resolution of workplace conflicts at earliest stage.          |
| >                                                                     |
| > Conducts program assessments and evaluations to ensure objectives   |
| > were met.                                                           |
| >                                                                     |
| > Where applicable, ensures that HHS, OPDIV, and program goals and    |
| > requirements for correcting grant, procurement, and finance system  |
| > weaknesses are achieved or exceeded.                                |
| >                                                                     |
| > Other aspects *(describe)*:                                         |
+-----------------------------------------------------------------------+
| *\*\* To be applied only to Team Leaders who have official position   |
| descriptions identifying them as team leaders.*                       |
+-----------------------------------------------------------------------+

+----------------------------------------------+----------------------+
| **NOTE:** The supervisor should determine,   |                      |
| by marking the appropriate box(es), which    |                      |
| aspects of this critical element apply to    |                      |
| the\                                         |                      |
| employee\'s job duties and responsibilities. |                      |
|                                              |                      |
| ####### For All Other Staff                  |                      |
+----------------------------------------------+----------------------+
| > Provides responsive service to             |                      |
| > internal/external customers that support   |                      |
| > customer and program requirements.         |                      |
| >                                            |                      |
| > Participates with supervisor in            |                      |
| > establishing individual performance plans, |                      |
| > and provides self-assessments if required. |                      |
| >                                            |                      |
| > Demonstrates integrity and adheres to      |                      |
| > Government-wide and HHS Standards of       |                      |
| > Ethical Conduct, including but not\        |                      |
| > limited to, avoiding conflicts of          |                      |
| > interest, participation in outside         |                      |
| > activities, political activity, financial  |                      |
| > disclosure, and use of government          |                      |
| > resources and equipment.                   |                      |
| >                                            |                      |
| > Treats others with respect; fosters a      |                      |
| > cooperative environment where differences  |                      |
| > and similarities in opinions are           |                      |
| > encouraged and communicated.               |                      |
| >                                            |                      |
| > Identifies and communicates individual     |                      |
| > developmental needs consistent with the    |                      |
| > agency mission; assists coworkers by       |                      |
| > mentoring, advising, or guiding them in    |                      |
| > understanding work assignments as          |                      |
| > appropriate.                               |                      |
| >                                            |                      |
| > Actively participates in identifying,      |                      |
| > communicating, and implementing quality    |                      |
| > improvements that ensure attainment of     |                      |
| > workforce goals.                           |                      |
| >                                            |                      |
| > When applicable, identifies and addresses  |                      |
| > weaknesses in grant system(s), procurement |                      |
| > systems, and finance offices to ensure     |                      |
| > recovery of improper payments and to       |                      |
| > reduce the number of improper payments     |                      |
| > made by the Department.                    |                      |
| >                                            |                      |
| > Other aspects *(describe)*:                |                      |
+----------------------------------------------+----------------------+
|                                              |                      |
+----------------------------------------------+----------------------+
| **ELEMENT**                                  | **RATING**           |
+----------------------------------------------+----------------------+
| **Administrative Requirements** **E**(5)     |                      |
| **FS**(3) **MS**(2) **U**(1)                 |                      |
+----------------------------------------------+----------------------+
|                                              |                      |
+----------------------------------------------+----------------------+
| **B.** ***INDIVIDUAL PERFORMANCE OUTCOMES -  |                      |
| CRITICAL ELEMENTS***                         |                      |
+----------------------------------------------+----------------------+
| **Individual Performance Outcomes** *(List   |                      |
| individual critical elements)*               |                      |
+----------------------------------------------+----------------------+
| **ELEMENT**                                  | **RATING**           |
+----------------------------------------------+----------------------+
| **1.** **E**(5) **FS**(3) **MS**(2) **U**(1) |                      |
+----------------------------------------------+----------------------+

Description: **Chemist Research Program** (Mandatory)

Specialized scientific support as a research chemist is provided in
developing new methods for the success of the research program within
the department, as well as the following duties:

-   Document research findings, methodologies;

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-   Develop or improve laboratory procedures and chemistry techniques.

-   Assist in analyzing and interpreting data and prepare summaries of
    laboratory findings;

-   Maintain literature and facility awareness;

-   Assist with planning and direction of research studies;

-   Ensure quality control and upkeep of the laboratory, to include
    ordering and maintaining equipment and supplies such as chemicals,
    biological materials.

**This element relates to, and supports objectives in, the "One HHS"
Program and Management Objectives, specifically, #5, Advance Medical
Research.**

+-----------------------------------------------------------------------+
| **2.** **E**(5) **FS**(3) **MS**(2) **U**(1)                          |
|                                                                       |
| Description: **Training/Mentoring**                                   |
|                                                                       |
| -   Scientists from other organizations or institutions involved in   |
|     similar or related research projects are interacted and           |
|     collaborated with;                                                |
|                                                                       |
| -   Training/mentoring is provided to others, including technical     |
|     personnel, fellows, students and special volunteers in the use of |
|     sophisticated laboratory equipment and in the performance of      |
|     specialized procedures, techniques, etc.                          |
|                                                                       |
| **This element also relates to, and supports objectives in, the "One  |
| HHS" Program and Management Objectives, specifically #5, Advance      |
| Medical Research.**                                                   |
+-----------------------------------------------------------------------+
| **3.** **E**(5) **FS**(3) **MS**(2) **U**(1)                          |
|                                                                       |
| > Description: **Publications/Presentations**                         |
|                                                                       |
| Alone or with collaborators, interpret and evaluate research findings |
| and prepare scientific papers for publication and/or presentation at  |
| scientific meetings, appropriate to the level of experience.          |
|                                                                       |
| **This element also relates to, and supports objectives in, the "One  |
| HHS" Program and Management Objectives, specifically #5, Advance      |
| Medical Research.**                                                   |
+-----------------------------------------------------------------------+
| **4.** **E**(5) **FS**(3) **MS**(2) **U**(1)                          |
|                                                                       |
| Description:                                                          |
+-----------------------------------------------------------------------+

+----------------------------------------------+-----------------------+
| **Individual Performance Outcomes** *(List   |                       |
| individual critical elements)*               |                       |
+----------------------------------------------+-----------------------+
| **ELEMENT**                                  | **RATING**            |
+----------------------------------------------+-----------------------+
| **5.** **E**(5) **FS**(3) **MS**(2) **U**(1) |                       |
|                                              |                       |
| Description:.                                |                       |
+----------------------------------------------+-----------------------+

+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **III.** **CONVERSION OF ELEMENTS TO SUMMARY RATING**                 |
+-----------------------------------------------------------------------+
| After rating and assigning a score to each critical element, the      |
| rating official will total the points and divide by the number of\    |
| critical elements, to arrive at an average score (up to one decimal   |
| place). This score will be converted to a summary rating\             |
| based on the following point values:                                  |
|                                                                       |
| **Total Point Value:       Divided by Number of Critical Elements:    |
| = Average Score:      **                                              |
|                                                                       |
| Average Score will be calculated up to 1 decimal place. This          |
| numerical score will then be converted to a Summary Rating,\          |
| as follows:                                                           |
|                                                                       |
| > **Exceptional:** 4.4 to 5 points                                    |
| >                                                                     |
| > **Fully Successful:** 3 to 4.3 points                               |
| >                                                                     |
| > **Minimally Successful:** 2 to 2.9 points                           |
| >                                                                     |
| > **Unacceptable:** 1 to 1.9 points                                   |
|                                                                       |
| This Summary Rating will be recorded on **Page 1** of this form.      |
|                                                                       |
| **Exceptions to the mathematical formula:**                           |
|                                                                       |
| -   If an employee receives Minimally Successful on one or more       |
|     critical elements, he/she cannot receive a summary\               |
|     rating of higher than Fully Successful, regardless of the average |
|     point score.                                                      |
|                                                                       |
| -   A summary rating of Unacceptable must be assigned to any employee |
|     who is rated Unacceptable on any critical\                        |
|     element.                                                          |
+-----------------------------------------------------------------------+

For progress review and/or summary rating. Optional, unless performance
is below Fully Successful.

     

**Exceptional (E):**

The employee performed as a model of excellence by surpassing
expectations. Indicators of performance at this level\
include outcomes that exceed Fully Successful level standards, for
critical elements described in the annual performance\
plan, and as measured by appropriate assessment tools. Examples include:

• Innovations, improvements, and contributions to management,
administrative, technical, or other functional areas that\
impact outside the work unit and facilitate organizational recognition;

• Increases in office and/or individual productivity;

• Improved customer, stakeholder, and/or employee satisfaction,
resulting in positive evaluations, accolades, and\
recognition; methodology is modeled outside the organization.
Flexibility and adaptability in responding to changing priorities,
unanticipated resource shortages, or other obstacles;

• Initiation of significant collaborations, alliances, and coalitions;

• Leadership on workgroups or teams, such as those that design or
influence improvements in program policies,\
processes, or other key activities;

• Anticipates the need for, and identifies, professional developmental
activities that prepare staff and/or oneself to meet\
future workforce challenges; and/or

• Consistently demonstrates the highest level of ethics, integrity and
accountability in achieving specific HHS, OPDIV, or\
programs goals; makes recommendations that foster clarification and/or
influence improvements in ethics activities.

**Fully Successful (FS):**

The employee met all critical elements, as described in the annual
performance plan, and as measured by appropriate\
assessment tools. Examples include:

• Planned, well-organized, and complete work assignments that reflect
requirements;

• Decisions and actions that demonstrate organizational awareness
including knowledge of mission, function, policies,\
technological systems, and culture;

• Independently follows-up on actions and improvements that impact the
immediate work unit; establishes and maintains\
strong relationships with employees and/or clients; understands their
priorities; balances their interests with\
organizational demands and requirements; effectively communicates
necessary actions to them and employee/customer\
satisfaction is conveyed.

• When serving on teams and workgroups, contributions are substantive
and completed according to standards;

• Resolution of operational challenges and problems without assistance
from higher-level staff;

• Acquires new skills and knowledge through traditional and other means
to meet assignment requirements; and/or

• Demonstration of ethics, integrity and accountability that achieve HHS
and agency goals.

**Minimally Successful (MS):**

The employee had difficulties in meeting expectations. This is the
minimum level of acceptable performance for retention on\
the job. Improvement is necessary. Examples include:

• Occasionally fails to meet assigned deadlines;

• Work assignments occasionally require major revisions or often require
minor revisions;

• Application of technical knowledge to completion of work assignments
is not reliable;

• Occasionally fails to adhere to required procedures, instructions,
and/or formats in completing work assignments;

• Occasionally fails to adapt to changes in priorities, procedures or
program direction; and/or

• The employee\'s impact on program performance, productivity, morale,
organizational effectiveness and/or customer\
satisfaction need improvement.

**Unacceptable (U):**

The employee failed to meet expectations. Immediate improvement is
essential for job retention. Examples include:

• Consistently fails to meet assigned deadlines;

• Work assignments often require major revisions;

• Fails to apply adequate technical knowledge to completion of work
assignments;

• Frequently fails to adhere to required procedures, instructions and/or
formats in completing work assignments; and/or

• Frequently fails to adapt to changes in priorities, procedures or
program direction.

Performance Plan

All elements of the performance plan are critical. Established
requirements must support HHS goals and objectives.

All employees will be rated on the Administrative Requirements critical
element (Part II.A. of the plan). In addition, the\
supervisor, with input from the employee, will develop and establish
specific outcomes in support of Agency strategic\
initiatives to be included as critical elements in the Individual
Performance Outcomes section (Part II.B. of the plan).

The performance plan should be signed and dated by the supervisor and
the employee in Part I.A. prior to implementation.

###### Progress Review

Supervisors will conduct at least one progress review, at approximately
the midpoint in the appraisal cycle. The supervisor\
must provide written documentation if performance on any element is less
than Fully Successful. The supervisor and the\
employee should sign and date Part I.B. after a progress review is
conducted. If the employee refuses to sign, the\
supervisor should annotate the form, \"Employee declined to sign.
Progress review conducted on \[date\].\"

###### Performance Appraisal

The supervisor will assign a rating to each critical element
(Administrative Requirements and the individual critical elements\
under the Individual Performance Outcomes). The rating level definitions
will be assigned a numerical score as follows:

> **Exceptional:** 5 points
>
> **Fully Successful:** 3 points
>
> **Minimally Successful:** 2 points
>
> **Unacceptable:** 1 point

After rating and assigning a score to each critical element, the rating
official will total the points and divide by the number of\
critical elements, to arrive at an average score (up to one decimal
place). This score will be converted to a summary rating\
based on the following point values:

> **Exceptional:** 4.4 to 5 points
>
> **Fully Successful:** 3 to 4.3 points
>
> **Minimally Successful:** 2 to 2.9 points
>
> **Unacceptable:** 1 to 1.9 points

**Exceptions to the mathematical formula:**

-   If an employee receives Minimally Successful on one or more critical
    elements, he/she cannot receive a summary\
    rating of higher than Fully Successful, regardless of the average
    point score.

-   A summary rating of Unacceptable will be assigned to any employee
    who is rated Unacceptable on any critical\
    element.

If required by the OPDIV Head, the supervisor will submit the rating to
the reviewing official for concurrence. The supervisor\
will conduct a performance discussion with the employee. The supervisor
and employee should sign and date Part I.C. The\
employee will be provided with a copy of the complete final rating of
record. If the employee refuses to sign, the supervisor\
should annotate the form, \"Employee declined to sign. Rating discussed
and copy provided on \[date\].\"

A copy will be provided to the employee and the original forwarded to
the designated individual within the OPDIV.