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Performance Feedback Process Appeal Form

This document outlines an employee performance feedback appeal process. It allows employees to formally appeal their annual performance evaluation if they believe the ratings do not accurately reflect their work. The appeal is first discussed informally with the evaluating supervisor. If unresolved, employees complete an appeal form within 10 days of receiving the evaluation. They identify specific ratings and facts in dispute. If the immediate supervisor cannot resolve it, the appeal moves up the chain of command through the Division Manager and Department Director. The final step is appealing to the Human Resources Director.

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Fanny Martdianty
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270 views2 pages

Performance Feedback Process Appeal Form

This document outlines an employee performance feedback appeal process. It allows employees to formally appeal their annual performance evaluation if they believe the ratings do not accurately reflect their work. The appeal is first discussed informally with the evaluating supervisor. If unresolved, employees complete an appeal form within 10 days of receiving the evaluation. They identify specific ratings and facts in dispute. If the immediate supervisor cannot resolve it, the appeal moves up the chain of command through the Division Manager and Department Director. The final step is appealing to the Human Resources Director.

Uploaded by

Fanny Martdianty
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PERFORMANCE FEEDBACK PROCESS APPEAL FORM

An employee may appeal an annual performance feedback appraisal where it is believed that the overall rating or individual
performance factor ratings do not represent a true evaluation of the employee’s work performance during the appraisal period.
Such appeal shall follow the normal chain of command up to and including the Department Director if necessary.
Within 10 days of receipt of a signed copy of the appraisal, the employee should meet with the evaluating supervisor in an
attempt to resolve the disagreement before filing a formal appeal. Though not required at this step, the appealing employee is
encouraged to complete and utilize this Performance Feedback Appeal Form as the basis of the initial discussion with the
supervisor. If not resolved in this informal discussion, the employee may formally appeal the evaluation by completing and
submitting this Performance Feedback Appeal Form to the evaluating supervisor within 10 days after receiving the signed copy
of the performance feedback rating. If the appeal is not resolved by the immediate supervisor, it is the appellant’s
responsibility to move the appeal through the subsequent steps in a timely manner (see Performance Feedback Appeal
Procedure).

EMPLOYEE NAME: DATE:

EMPLOYEE JOB TITLE: SUPERVISOR NAME:

DATE OF EVALUATION: DATE COPY RECEIVED:

NOTE: A complete copy of the Performance Feedback Rating Form that you are appealing (signed by the evaluating
supervisor) must be submitted with this appeal at each step of the formal appeal process.

1. IDENTIFY THE SPECIFIC PERFORMANCE FACTOR RATING(S) YOU ARE CONTESTING, e.g., interpersonal
skills, flexibility/adaptability, teamwork:

2. IDENTIFY: a.) THE SUPERVISOR’S RATING FOR EACH FACTOR YOU ARE APPEALING, AND b.) THE
RATINGS YOU PROPOSE FOR EACH FACTOR YOU ARE APPEALING:

3. DESCRIBE THE SPECIFIC FACTS TO SUPPORT YOUR APPEAL OF EACH PERFORMANCE FACTOR
RATING. Attach additional sheets if necessary. (Attach applicable evidence):

__________________________________________ ____________________________________________
Signature of appellant Date Submitted to Immediate Supervisor

IMMEDIATE SUPERVISOR

__________________________________ ____________________________________________
Signature of Immediate Supervisor (reflects receipt only) Date of receipt of this completed appeal form

See page 2 for immediate supervisor decision box and signature boxes for Division Manager and Department Director.
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PERFORMANCE FEEDBACK PROCESS APPEAL FORM

EMPLOYEE NAME: ________________________________

IMMEDIATE SUPERVISOR

The following solution was reached and the revised performance feedback appraisal form is attached:

We have not resolved this appeal; the employee may forward appeal to the next level of management.

Appellant Signature _______________________________________ Date: _____________________

Immediate Supervisor Signature: ______________________________Date: _____________________

DIVISION MANAGER / NEXT LEVEL OF MANAGEMENT ABOVE EVALUATING SUPERVISOR

Date appeal was received: _______________

The following solution was reached and the revised performance feedback appraisal form is attached:

We have not resolved this appeal; employee may forward appeal to the Department Director.

Appellant Signature _______________________________________ Date: _____________________

Division Manager Signature: _________________________________ Date: _____________________

DEPARTMENT DIRECTOR

Date appeal was received: _______________

The following solution was reached and the revised performance feedback appraisal form is attached:

We have not resolved this appeal; employee may forward appeal to the Human Resources Director.

Appellant Signature _____________________________________________ Date: _______________

Department Director Signature: ____________________________________ Date: ________________

ATTACH ADDITIONAL SHEETS IF NECESSARY.

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