Page 212 - Personnel Policy and Procedures Manual

Form RM-WC-TDPE

TEMPORARY DUTY PERFORMANCE EVALUATION
(Temporary duty to last for up to 12 weeks with one additional 12 week extension if necessary)

Name - Emp. ID # - SSN -

Temporary Job Title - Rating Period -

1. Conduct -

2. Absenteeism/Tardiness -

3. Work habits -

4. Communication -

Supervisor’s Comments -

Supervisor’s Signature/Title - Today’s Date
-

Employee’s Signature - Today’s Date
-

My signature does not indicate my agreement with this evaluation
____________________________________________________________________________________

Return completed form to Risk Management - Judy Blackstone, Worker’s Compensation Coordinator 530
Greene Street, Room 212
706-821-230

All Rights Reserved – As approved by the Commission on 05-07-2019 211 | P a g e