1. 8B Eval Log Send Self Eval to Employee Staff turn in Date Eval Due Date Date Sent to EE by Assist Admin NAME Brandy or Laura Classification Hire Month Hire Day Comments (for new hires include probationary due date) DATE Completed Probat Eval done 1-Dec21-Dec31-Jan3-DecLC15 1/14naM+ 4/4 1-Dec21-Dec31-Jan3-DecBC115 3/27 na M4/4 1-Dec21-Dec31-Jan3-DecBC121 3/20 na M-4/3 1-Dec21-Dec31-Jan3-DecLC120 1/18naM4/4 1-Jan21-Jan28-Feb26-DecBNAII217 4/2naP-na 1-Feb21-Feb31-Mar5-FebBC33 4/2naM 4/3

2. 8B E-mailed to EE

3. 8b RN Eval Procedure YOU CAN FIND THE EVALUATION TOOL AND RN PEER INPUT TOOL AT THE JIT WEBSITE http://www.med.umich.edu/nursing/jit/forms.htm SELECT THE PERFORMANCE EVALUATION FOR YOUR LEVEL: Follow the instructions that are attached to the evaluation tool (also pasted below). Key Dates to remember – the Peer input should be returned to you within 7 days. The peer review forms are returned to you. You are to review the content and summarize the information on the performance review form in the peer feedback section of the self evaluation. You will submit your completed Staff Performance Planning and Evaluation form via e-mail (preferred) and your Peer Review forms to the manager by the 21 st of the month the e-mail is received. Example: E-mail received in May, elements due by May 21. If materials are not submitted by the established due date, the manager/supervisor will proceed with completing the evaluation process. You may want to reference the peer input tool when completing your self evaluation as well as the attached Performance Evaluation Rating Descriptions Be sure to include an Annual Plan your Goals (1-2). – Goals should be Specific, Measurable, Achievable, Realistic, and Timed. Example: I will be come an ONS member by July 2008. – This goal is » specific – becoming an ONS member, » measurable – either achieved or not achieved, » achievable – not hard to do » realistic – nurse should be able to do this » time – there is a date listed

4. 8B Peer Feedback Instructions Dear: Please complete the attached peer review of me. Please provide appropriate feedback. Please support your views with concrete examples. Please add what opportunities you see I have for my growth. There is a short time frame for you to complete and return the feedback so that I may be able to include your feedback in my Staff Performance Planning and Evaluation. Please return this peer feedback to me by: (7 days) If I do not have your peer feedback, I will not be able to include it and I will not be able to have a well rounded Staff Performance Planning and Evaluation. Thank you very much for participating in my annual evaluation,

5. 8B Templates to add to Evals Peer Feedback Clinical Skills and Knowledge – Peer rated at levels – Describe a time when you saw me at my very best. What qualities did I display in this domain? – Provide your input regarding opportunities for my personal and/or professional growth. Therapeutic Relationships – Peer rated at levels – Describe a time when you saw me at my very best. What qualities did I display in this domain? – Provide your input regarding opportunities for my personal and/or professional growth Professional Relationships – Peer rated at level – Describe a time when you saw me at my very best. What qualities did I display in this domain? – Provide your input regarding opportunities for my personal and/or professional growth. Professional Development – Peer rated at levels – Describe a time when you saw me at my very best. What qualities did I display in this domain? – Provide your input regarding opportunities for my personal and/or professional growth. Advancing Practice through Innovation and Research – Peer rated at levels – Describe a time when you saw me at my very best. What qualities did I display in this domain? – Provide your input regarding opportunities for my personal and/or professional growth All Peer feedback is typed into the EE evaluation

6. 8B Templates to add to Evals We also include individual scorecard data r/t unit audited areas and central audited areas We log Making a difference/ect and copy/paste under customer feedback

7. 8B Qualtrics Feedback

8. 8B All job class is set up in a similar fashion Log helps keep on tract and up to date Process helps to organize but does not help to make the process faster Received minimal feedback with Qualtrics