Goal Setting And Review Form

Review Period (20 – 20 )

Name:	Department:
Title:	Supervisor:
Grade:	Supervisor’s Title:
DOH in Position: Date:

Please use this document to list your goals for the upcoming review period in collaboration with your supervisor. Your goals should be linked directly to your department's mission and we recommend they are written in SMART goal format. You should also include a description of each goal, the results you anticipate and your action plan and timetable to achieve anticipated results. You should complete a first draft of your goals. After completing your initial draft, review it with your supervisor; the final draft of your initial goals should be reviewed and approved by June 30.

Please review and discuss your initial goals with your supervisor mid-way through the review period (by mid-December). During this mid-year review, you should discuss your progress as well as the need to modify and/or replace any goals. You and your supervisor should keep copies of this collaborative document. Please note this form does not need to be submitted to Human Resources.

Goal
Anticipated Results
Action Plan/Timetable
Training Needed
Mid-Year Review Supervisor’s Comments

Goal
Anticipated Results
Action Plan/Timetable
Training Needed
Mid-Year Review Supervisor’s Comments

Goal
Anticipated Results
Action Plan/Timetable
Training Needed
Mid-Year Review Supervisor’s Comments

Goal
Anticipated Results
Action Plan/Timetable
Training Needed
Mid-Year Review Supervisor’s Comments

Additional Mid-Year Comments

Initial Goal Setting:

We have reviewed and agreed to the above goals.

__________________________________	________________________	____________

Staff Member Signature	Supervisor Signature	Date

Mid-Year Review:

We have reviewed and agreed to the above goals/revisions.

__________________________________	________________________	____________

Staff Member Signature	Supervisor Signature	Date