26
Flyers Energy Annual Performance Appraisal
Cashier Team Members
Guest Service Demonstration: Date of Observation: _______________ Time frame of Observation: _____________________ *Circle rating for each category:
Verbal Interactions: Awareness of Surroundings: Consistency: Poor Fair Good Excellent Poor Fair Good Excellent Poor Fair Good Excellent Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Competency Ratings:
Team Member Name:
Position: Cashier Team Member
Company: Co.1: Flyers Energy, LLC
Department: (Site Number)
Appraisal Period: Appraisal Date:
5: Outstanding* Consistently exceeds expectations. Regularly goes above and beyond. 4: Highly Effective Occasionally demonstrates the willingness and ability to independently exceed expectations.3: Satisfactory Fully and accurately satisfies the position's scope of responsibility on a regular basis. 2: Needs Improvement Occasionally fails to satisfy expectations and/or requirements.
1: Unacceptable* Performance consistently fails to meet minimum expectations or is fundamentally lacking. *Ratings of 1 or 5 require supervisor's comments
Rat
ing
(1-5
): Guest Service:
Energy: Comments:
Awareness of essential interactions:
Comments:
Consistence: Comments:
Paperwork:
Completeness: Comments:
Organization: Comments:
Consistence: Comments:
Total point value of competency ratings page 1 of 2:
Attendance and Scheduling Flexibility: Team Members are expected to appear for all assigned shifts and notify supervisor of any schedule change requests with ample notice.
Comments:
Presentation/Personnel Standards compliance: Team Member's presentation and personal grooming must be maintained in compliance with Personnel Standards policy. Nametag to be worn at all times.
Comments:
Teamwork: Team Members are expected to cooperate with co-workers and actively facilitate a pleasant working environment.
Comments:
Suggestive Selling: All Team Members demonstrating consistent suggestive selling should enhance both guest service and product sales.
Comments:
Cleaning/Maintenance: It is imperative that all team members contribute to maintaining a clean and safe working environment.
Comments:
Innovations and New Ideas: We are committed to the pursuit of excellence in its simplest form. We can never be satisfied. All Team Members have the opportunity to identify and submit ideas for improvement.
Comments:
Total point value of competency ratings page 2 of 2:
*Total 60 possible points. Average= (Total / 60) x 100
5: Outstanding* Consistently exceeds expectations. Regularly goes above and beyond. 4: Highly Effective Occasionally demonstrates the willingness and ability to independently exceed expectations.3: Satisfactory Fully and accurately satisfies the position's scope of responsibility on a regular basis. 2: Needs Improvement Occasionally fails to satisfy expectations and/or requirements.
1: Unacceptable* Performance consistently fails to meet minimum expectations or is fundamentally lacking. *Ratings of 1 or 5 require supervisor's comments
Rat
ing
(1-5
):
Previous Appraisal Current Appraisal
Total Points
Overall Score
Total Points
Overall Score
Page 1: Page 2: Total Score:
Performance goals defined in previous performance appraisal: 1) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Objective 1 is: Completed: In progress: Not addressed: No longer applicable: 2) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Objective 2 is: Completed: In progress: Not addressed: No longer applicable: 3) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Objective 3 is: Completed: In progress: Not addressed: No longer applicable: Performance goals for current appraisal period: 1) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 2) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 3) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________
Supervisor’s Comments: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Team Member’s Comments: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Pay Rate Adjustment: Not Applicable: or Will be Adjusted: If Adjustment is applicable:
Current Rate: Effective Date of Change: Adjusted Rate:
Acknowledgements: _____________________________ _________________________________ ______ Team Member’s Name (print) Team Member’s Signature Date _____________________________ _________________________________ ______ Supervisor’s Name (print) Supervisor’s Signature Date
Flyers Energy Annual Performance Appraisal
Food Service Team Members
Sandwich Preparation Demonstration:
Type of Sandwich: ___________________________ Seconds taken to Prepare: __________ *Circle rating for each category:
Competency Ratings:
Team Member Name:
Position: Food Service Team Member
Company: Co.1: Flyers Energy, LLC
Department: (Site Number)
Appraisal Period: Appraisal Date:
Eye Appeal: Poor Fair Good Excellent
Efficiency: Poor Fair Good Excellent
Formula: Poor Fair Good Excellent
5: Outstanding* Consistently exceeds expectations. Regularly goes above and beyond. 4: Highly Effective Occasionally demonstrates the willingness and ability to independently exceed expectations.3: Satisfactory Fully and accurately satisfies the position's scope of responsibility on a regular basis. 2: Needs Improvement Occasionally fails to satisfy expectations and/or requirements.
1: Unacceptable* Performance consistently fails to meet minimum expectations or is fundamentally lacking. *Ratings of 1 or 5 require supervisor's comments
Rat
ing
(1-5
):
Product Preparation:
Understanding: Comments:
Speed: Comments:
Accuracy: Comments:
Paperwork:
Completeness: Comments:
Accuracy: Comments:
Organization: Comments:
Total point value of competency ratings page 1 of 2:
Observation Notes:
Attendance and Scheduling Flexibility: Team Members are expected to appear for all assigned shifts and notify supervisor of any schedule change requests with ample notice.
Comments:
Presentation/Personnel Standards compliance: Team Member's presentation and personal grooming must be maintained in compliance with Personnel Standards policy.
Comments:
Teamwork: Team Member's are expected to cooperate with co-workers and actively facilitate a pleasant working environment.
Comments:
Guest Service: We create value for our guests through an extremely high level of guest service. All team members must embrace this Flyers Core Value.
Comments:
Suggestive Selling: All Team Members demonstrating consistent suggestive selling should enhance both guest service and product sales.
Comments:
Cleaning/Maintenance: It is imperative that all team members contribute to maintaining a clean and safe working environment.
Comments:
Innovations and New Ideas: We are committed to the pursuit of excellence in its simplest form. We can never be satisfied. All Team Members have the opportunity to identify and submit ideas for improvement.
Comments:
Total point value of competency ratings page 2 of 2:
*Total 65 possible points. Average= (Total / 65) x 100
5: Outstanding* Consistently exceeds expectations. Regularly goes above and beyond. 4: Highly Effective Occasionally demonstrates the willingness and ability to independently exceed expectations.3: Satisfactory Fully and accurately satisfies the position's scope of responsibility on a regular basis. 2: Needs Improvement Occasionally fails to satisfy expectations and/or requirements.
1: Unacceptable* Performance consistently fails to meet minimum expectations or is fundamentally lacking. *Ratings of 1 or 5 require supervisor's comments
Rat
ing
(1-5
):
Previous Appraisal Current Appraisal
Total Score
Average Score
Total Score
Average Score
Page 1: Page 2: Total Score:
Performance goals defined in previous performance appraisal: 1) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Objective 1 is: Completed: In progress: Not addressed: No longer applicable: 2) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Objective 2 is: Completed: In progress: Not addressed: No longer applicable: 3) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Objective 3 is: Completed: In progress: Not addressed: No longer applicable: Performance goals for current appraisal period: 1) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 2) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 3) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________
Supervisor’s Comments: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Team Member’s Comments: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Pay Rate Adjustment: Not Applicable: or Will be Adjusted: If Adjustment is applicable:
Current Rate: Effective Date of Change: Adjusted Rate:
Acknowledgements: _____________________________ _________________________________ ______ Team Member’s Name (print) Team Member’s Signature Date _____________________________ _________________________________ ______ Supervisor’s Name (print) Supervisor’s Signature Date
Flyers Energy Annual Performance Appraisal
Assistant Manager
Demonstrations: Management team members are expected to uphold standards and adhere to stated policies and procedures on a regular and ongoing basis. While this review does include notes and observations resulting from a recent spot audit of the Assistant Manager’s performance, it is also reflective of the Assistant Manager’s performance throughout the Appraisal Period indicated above. Where applicable, Observation Notes are included to cite observations that have been made throughout the Appraisal Period. Guest Service: The Assistant Manager is expected to provide exceptional guest service not only to the external guests and vendors who frequent our sites, but also to internal guests including other team members and other departments. *Circle rating for each category:
Verbal Interactions: Awareness of Surroundings: Consistency: Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)
Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Interactions With and & Contributions to Management team: Assistant Managers are expected to coordinate with their fellow management team members in the resolution of shared challenges and actively participate in group meeting. *Circle rating for each category:
Coordinates with other Assistant Managers when appropriate Participates in group meetings
Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Team Member Name: Position:
Company: Co.1: Flyers Energy, LLC
Department: (Site Number)
Appraisal Period: Appraisal Date:
Paperwork Organization Demonstration: All control and tracking forms must be regularly maintained and accurate *Circle rating for each category:
Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Development of direct reports: A fundamental responsibility of the Assistant Manager is to develop the team members whom he or she is entrusted to supervise. Team member development includes ensuring that the team members have a full and complete understanding of their scope of responsibility, that they demonstrate a willingness and desire to improve and that they are actively engaged in the store’s operations.
Provides effective, clear and consistent training of new Cashier team members.
Actively works to develop existing Cashier team members to be viable Assistant Manager
applicant(s) Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)
Assumes responsibility for tasks and projects.
Proactively identifies opportunities for improvement and upholds this expectation among Cashier TM’s.
Holds Cashier TM’s accountable for unsatisfactory performance and assigns responsibilities
appropriately. Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)
Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Paperwork clutter is kept to a minimum E-mail correspondence are clear, concise and timely Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)
Can effectively develop a basic labor
schedule Can properly complete and submit both Friday Highlights
and Weekly Numbers to Area Manager Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)
Competency Ratings:
Assistant Managers are responsible for not only upholding and promoting the following standards themselves, but also fully supporting their Store Manager in maintaining these standards.
Guest Service: Ensuring that all team members are consistently providing the highest level of guest service. To what extend do store operations consistently demonstrate the highest level of guest service while under his/her supervision:
Comments:
Attendance and Scheduling Flexibility: Ensuring that the store remains fully staffed and budgeted hours are effectively utilized. To what extent is the site effectively scheduled to achieve full coverage and minimal overtime:
Comments:
Presentation/Personnel Standards compliance: Ensuring regular and consistent adherence to presentation and dress code standards. To what extent are all team members regularly found to be in full compliance with Personnel Standards:
Comments:
Teamwork: Driving teamwork and cooperation among the entire team. To what extent do team members work well together and support each other:
Comments:
Suggestive Selling: Upholding all marketing efforts and driving increased merchandise sales performance. To what extent do all team members make a clear and concerted effort to improve merchandise sales performance:
Comments:
Cleaning/Maintenance: Overall cleanliness and appearance of the store. All essential equipment must be kept in good working order and all areas must be kept in a clean and orderly state. To what extent is the store regularly maintain exceptionally clean and well kept standards:
Comments:
Innovations and New Ideas: We are committed to the pursuit of excellence in its simplest form. We can never be satisfied. Assistant Managers are expected to continually look for opportunities for improvement and submit such ideas to their Store Manager. To what extent does the Assistant Manager strive to improve upon current operations:
Comments:
Previous Appraisal Current Appraisal
Total Points
Average Score
Total Points
Average Score
Demonstration Section Points: Competency Section Points: Total Score:
5: Outstanding* Consistently exceeds expectations. Regularly goes above and beyond. 4: Highly Effective Occasionally demonstrates the willingness and ability to independently exceed expectations.3: Satisfactory Fully and accurately satisfies the position's scope of responsibility on a regular basis. 2: Needs Improvement Occasionally fails to satisfy expectations and/or requirements.
1: Unacceptable* Performance consistently fails to meet minimum expectations or is fundamentally lacking. *Ratings of 1 or 5 require supervisor's comments
Rat
ing
(1-5
):
*Total 100 possible points. Total Score= Average Score. Example: 75pts = 75%
Performance goals defined in previous performance appraisal: 1) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Objective 1 is: Completed: In progress: Not addressed: No longer applicable:
2) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Objective 2 is: Completed: In progress: Not addressed: No longer applicable:
3) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Objective 3 is: Completed: In progress: Not addressed: No longer applicable:
Performance goals for current appraisal period: 1) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 3) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Supervisor’s Comments: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Team Member’s Comments: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Pay Rate Adjustment:
Not Applicable: or Will be Adjusted: If Adjustment is applicable:
Current Rate: Effective Date of Change: Adjusted Rate:
Acknowledgements: _____________________________ _________________________________ ______ Team Member’s Name (print) Team Member’s Signature Date _____________________________ _________________________________ ______ Supervisor’s Name (print) Supervisor’s Signature Date
Flyers Energy Annual Performance Appraisal
Store Manager
Demonstrations: Management team members are expected to uphold standards and adhere to stated policies and procedures on a regular and ongoing basis. While this review does include notes and observations resulting from a recent spot audit of the Store Manager’s performance, it is also reflective of the Store Manager’s performance throughout the Appraisal Period indicated above. Where applicable, Observation Notes are included to cite observations that have been made throughout the Appraisal Period. Guest Service: The Store Manager is expected to provide exceptional guest service not only to the external guests and vendors who frequent our sites, but also to internal guests including other team members and other departments. *Circle rating for each category:
Verbal Interactions: Awareness of Surroundings: Consistency: Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)
Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Marketing Demonstration: The Store Manager is responsible for ensuring ongoing compliance with all marketing efforts. *Circle rating for each category:
Proper Signage is Displayed: All Items are Properly Priced: Displays are Visually Appealing:
Yes (3) No (0) Yes (3) No (0) Poor (0) Fair (1) Good (3) Excellent (5) Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Team Member Name: Position:
Company: Co.1: Flyers Energy, LLC
Department: (Site Number)
Appraisal Period: Appraisal Date:
Paperwork Organization Demonstration: All control and tracking forms must be regularly maintained and accurate *Circle rating for each category:
All Documentation are Current All Documentation are Properly
Stored Paperwork clutter is kept to a minimum
Yes (3) No (0) Yes (3) No (0) Poor (0) Fair (1) Good (3) Excellent (5) Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Quarterly Inspections Performance: Store Managers are expected to maintain an average quarterly inspection score of no less than 90% Previous Quarterly Inspection scores are as follows:
Current Score is: <70% (0) 70%-80% (1) 80%-90% (3) >90% (5)
This Review's score is _____ compared to prior review:
Down >5% (0) Within 5% (3) Up >5% (5)
All 4 scores >90%: Yes (3) No (0)
Observation Notes __________________________________________________________ __________________________________________________________
_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Profit and Loss (P & L) Oversight: All control and tracking forms must be regularly maintained and accurate *Circle rating for each category:
Controllable Expenses are minimized Manager is aware of his/her GP$ trends and causes of anomalies Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5) Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Date: Score: 1 2 3 4
Total: Average:
Previous Review's Average:
Interactions With and & Contributions to Management team: Store Managers are expected to coordinate with their fellow managers in the resolution of shared challenges and actively participate in group meeting. *Circle rating for each category:
Coordinates with other Managers when appropriate Participates in Group Meetings
Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5) Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Development of direct reports: A fundamental responsibility of the Store Manager is to develop the team members whom he or she is entrusted to supervise. Direct report development includes ensuring that the team members have a full and complete understanding of their scope of responsibility, that they demonstrate a willingness and desire to improve and that they are actively engaged in the store’s operations.
Bad turnover is minimal while good turnover is properly administered
Actively works to develop ASM('s) to be viable Store Manager applicant(s)
Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5)
Manager is regularly scheduled to work with and develop each direct report
Manager understands strengths/weaknesses of each direct report. Capitalizes on strengths and provides training to improve upon weaknesses
Poor (0) Fair (1) Good (3) Excellent (5) Poor (0) Fair (1) Good (3) Excellent (5) Observation Notes ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Competency Ratings:
Guest Service: Store Managers are responsible for ensuring that all team members are consistently providing the highest level of guest service. To what extend do store operations consistently demonstrate the highest level of guest service:
Comments:
Attendance and Scheduling Flexibility: Store Managers are responsible for ensuring that the store remains fully staffed and budgeted hours are effectively utilized. To what extent is the site effectively scheduled to achieve full coverage and minimal overtime:
Comments:
Presentation/Personnel Standards compliance: Store Managers are responsible for ensuring regular and consistent adherence to presentation and dress code standards. To what extent are all team members regularly found to be in full compliance with Personnel Standards:
Comments:
Teamwork: Store Managers are responsible for driving teamwork and cooperation among their entire team. To what extent do team members work well together and support each other:
Comments:
Suggestive Selling: Store Managers are responsible for upholding all marketing efforts and driving increased merchandise sales performance. To what extent do all team members make a clear and concerted effort to improve merchandise sales performance:
Comments:
Cleaning/Maintenance: Store Managers are responsible for the overall cleanliness and appearance of the store. All essential equipment must be kept in good working order and all areas must be kept in a clean and orderly state. To what extent is the store regularly maintain exceptionally clean and well kept standards:
Comments:
Innovations and New Ideas: We are committed to the pursuit of excellence in its simplest form. We can never be satisfied. Store Managers are expected to continually look for opportunities for improvement and submit such ideas to their Area Manager. To what extent does the Store Manager strive to improve upon current operations:
Comments:
Previous Appraisal Current Appraisal
Total Points
Average Score
Total Points
Average Score
Demonstration Section Points: Competency Section Points: Total Score:
5: Outstanding* Consistently exceeds expectations. Regularly goes above and beyond. 4: Highly Effective Occasionally demonstrates the willingness and ability to independently exceed expectations.3: Satisfactory Fully and accurately satisfies the position's scope of responsibility on a regular basis. 2: Needs Improvement Occasionally fails to satisfy expectations and/or requirements.
1: Unacceptable* Performance consistently fails to meet minimum expectations or is fundamentally lacking. *Ratings of 1 or 5 require supervisor's comments
Rat
ing
(1-5
):
*Total 100 possible points. Total Score= Average Score. Example: 75pts = 75%
Performance goals defined in previous performance appraisal: 1) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Objective 1 is: Completed: In progress: Not addressed: No longer applicable:
2) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Objective 2 is: Completed: In progress: Not addressed: No longer applicable:
3) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Objective 3 is: Completed: In progress: Not addressed: No longer applicable:
Performance goals for current appraisal period: 1) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 3) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Supervisor’s Comments: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Team Member’s Comments: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Pay Rate Adjustment:
Not Applicable: or Will be Adjusted: If Adjustment is applicable:
Current Rate: Effective Date of Change: Adjusted Rate:
Acknowledgements: _____________________________ _________________________________ ______ Team Member’s Name (print) Team Member’s Signature Date _____________________________ _________________________________ ______ Supervisor’s Name (print) Supervisor’s Signature Date
Nella Oil Company: Performance Review LogTeam Member's Name Location
Date of Incident Incident Details Supervisor's Actions
Team Member's Response
Date Discussed With Team
MemberManager Signature
Area Manager Signature
C O N T A C T F O R M
DATE: ____________
TO: ___________________________
FROM: ___________________________
RE: ______________________________________________
____________________________ ____________________________ ______ Team Member’s Name: Team Member’s Signature: Date:
______ Team Member was presented with this Contact Form, but refused to sign on: Date: ____________________________ ____________________________ ______ Supervisor’s Name: Supervisor’s Signature: Date:
Disciplinary Notice Team Member’s name:___________________________ Department: _______ Communication Date:________ This Disciplinary Notice serves as formal documentation of a:
___Verbal Warning ___Disciplinary Suspension ___Written Warning Suspension Start Date: ……………….____________ ___Written Final Warning Suspension End Date (no later than): ____________
Statement of unacceptable conduct:
Did the incident cause a financial loss to the Company: Yes___ No___ If yes: Cost $_______ (or) Undetermined ___ Specific offense or rule violation:
Source:……………………………………….________________________________________________________
Page or Section:....…………………………_________________________________________________________
Reference Number / Procedure Title:.……_________________________________________________________
Stated policy, rule, or conduct expectation:
Previous disciplinary actions taken *Pertaining to specific offense or rule violation demonstrated by unacceptable conduct: Final Date of Communication/ End Date Warning Start Date (If applicable) ___ Verbal Warning ___ Written Warning ___ Disciplinary Suspension ____ ________ _________ ___ Verbal Warning ___ Written Warning ___ Disciplinary Suspension ____ ________ _________ ___ Verbal Warning ___ Written Warning ___ Disciplinary Suspension ____ ________ _________ ___ Verbal Warning ___ Written Warning ___ Disciplinary Suspension ____ ________ _________ Additional infractions of this policy or standard may result in further disciplinary action up to and including termination of employment. Final Warning: NO____ YES____TM Initials_________
Team Member Comments:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________ Supervisor Comments:
____________________________ ____________________________ ______ Team Member’s Name: Team Member’s Signature: Date:
______ Team Member was presented with this Disciplinary Notice, but refused to sign on: Date: ____________________________ ____________________________ ______ Supervisor’s Name: Supervisor’s Signature: Date:
I acknowledge that non-compliance with the above stated policy, rule or conduct expectation, or any other Company policy, rule or conduct expectation may result in separation of my employment.
Investigative Suspension Team Member’s name (recipient):……………….._____________________________________________ Team Member’s location (department)………….. ____________ Date of Communication:……………………………____________ Statement of conduct being investigated:
An Investigative Suspension is a period, not to exceed five (5) business days, during which time a team member is relieved of his or her responsibilities due to alleged serious misconduct. A team member may be placed on an Investigative Suspension when it is necessary to conduct a full and in-depth investigation to determine the facts surrounding a potential violation of Company policies or standards. If following an Investigative Suspension: Discharge is warranted, the team member shall not be paid for the period of the
Investigative Suspension – separation of employment shall be effective upon notification to the team member of such action.
Misconduct is determined, but not of a sufficiently serious nature to warrant discharge, the team member shall receive a disciplinary notice and forfeit wages lost as a result of the investigative suspension and may be placed on Disciplinary Suspension.
No misconduct is determined, the team member shall return to work in accordance with their working schedule and be paid for the time lost as a result of the investigative suspension.
Suspension Start Date: ____________ Suspension End Date (no later than): ____________
Team Member Comments:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Supervisor Comments:
____________________________ ____________________________ ______ Team Member’s Name: Team Member’s Signature: Date:
Team Member was presented with this Investigative Suspension form, but refused to sign on:
____________________________ ____________________________ ______ Supervisor’s Name: Supervisor’s Signature: Date:
______ Date:
Declaration
I, ___________________________ acknowledge that I stole____________________ at a value of _____________________ from Flyers Energy on date(s)___________________. I make this statement of my own free will and under penalty of perjury; I declare that the above is true and correct. ________________________________ _________________ Print Name Date _________________________________ Signature
Authorization of Payroll Deduction on Final Check
I authorize Flyers Energy to deduct________________ from my final check in payment of admitted theft. I make this authorization of my own free will and I understand that I am under no legal obligation to make this authorization. ________________________________ _________________ Print Name Date _________________________________ Signature
Witness Print Name Signature Date
Witness Print Name Signature Date
