STATE OF GEORGIA

PERFORMANCE MANAGEMENT FORM

Employee Name: Margaret Banks Emp. ID #: Job Title: SST

Manager Name: Tiffany Green Department: Day Hab- Cairo
Review Period: From: 12/30/19 To: 06/30/20
What Sections will you be using in your evaluation?
All Sections (1, 2 and 3) Users must click on the drop down arrow to the left of this field to select which form sections will be included in the overall rating.
Score the performance in each job factor below on a scale of 5-1 or N as follows:
5 = Exceptional Performer Employee exceeded all performance expectations. Employee was an exceptional contributor to the success of his/her
department and the State of Georgia. He/she demonstrated role model behaviors.

4 = Successful Performer-Plus Employee met all and exceeded most (more than 50%) of the established performance expectations.

3 = Successful Performer Employee met all performance expectations and may have exceeded some (less than 50%). Employee was a solid contributor
to the success of his/her department and the State of Georgia

2 = Successful Performer – Minus Employee met most (more than 50%), but failed to meet some performance expectations. Employee needs to further improve
in one or more areas of expected job results or behavioral competencies.

1 = Unsatisfactory Performer Employee did not meet all or most (more than 50%) of the established performance expectations. Employee needs significant
improvement in critical areas of expected job results or behavioral competencies.

N = Not rated: At the agency’s discretion, a new hire or transfer within five months of the end of the performance period may or may not
receive a performance rating.

Section 1: Individual / Core Competencies (25% minimum of total score)

Core Competencies (All Employees) Comments Rating
Customer Service - Understands that all employees have customers, internal and external, Shows professionalism when dealing with outside customers, greets
that they provide services and information to; honors all of the State’s commitments to all those that walk in the door, helps in calling other agencies,
customers by providing helpful, courteous, accessible, responsive, and knowledgeable service. parents/providers when problems arise or information is needed 5

Teamwork and Cooperation - Cooperates with others to accomplish common goals; works Works well with others within the Dept. Helps out her Cairo team if
with employees within and across his/her department to achieve shared goals; treats others short-staffed. Gives dignity & respect to not only staff but the
with dignity and respect and maintains a friendly demeanor; values the contributions of others. individuals. Maintains a friendly demeanor, values the contributions of 5
others suggestions or ideas.

Results Orientation - Consistently delivers required business results; sets and achieves Completes all required manatory trainings
achievable, yet aggressive, goals; consistently complies with quality standards and meets 3
deadlines; maintains focus on Agency and State goals.

DOAS Human Resources Administration 1 Revised 10/2012

Accountability - Accepts full responsibility for self and contribution as a team member; Definitely can count on showing up for work and completing task that
displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to have been asked of you by Day Hab Director. Makes sure that staff
organizational success and inspires others to commit to goals; demonstrates a commitment to are prepared for ISP staffings, making sure staff are aware of new
things that are being implemented. 5
delivering on his/her public duty and presenting oneself as a credible representative of the
Agency and State to maintain the public’s trust.

Judgment and Decision Making - Analyzes problems by evaluating available information and Please refer to assigned direct supervisor or dept manager when
resources; develops effective, viable solutions to problems which can help drive the there is an issue with an individual regarding health & safety from
effectiveness of the department and/or State of Georgia. other Depts here at TGSC or other agencies. Analyzes any potential
problems that may arise within the building and makes a judgment 4
call if necessary and if has any issues will make contact with the
SSPC I to go over anything that is pressing.

Leadership Competencies (people managers & other leaders) Comments Rating

Talent Management - Clearly establishes and communicates goals and accountabilities; Making sure that assigned staff are prepared for ISP staffings,
monitors and evaluates performance; provides effective feedback and coaching; identifies making sure that HRST trainings are completed, making sure that
development needs and helps employees address them to achieve optimal performance and progress notes are in each day, incident reports are completed with 4
24 hrs as policy specifies. Helps troubleshoot needs that assigned
gain valuable skills that will translate into strong performance in future roles.
staff are having to achieve performance.

Transformers of Government - Develops, recommends, or implements innovative Continue to provide all the necessary documentation that is required
approaches to address problems and drive continuous improvement in State programs and from HR for TGSC position, continue to go to all required trainings
processes; drives effective and smooth change initiatives across the State by communicating, throughout the year.
4
confirming understanding and activity working with stakeholders to overcome resistance.

Other Behavioral Competencies Comments Rating

Note: Calculate the overall section rating by adding the ratings for the individual items in the Overall Section Rating:
section, and then by dividing that total by the number of items in the section.
4.3
Section Weight (not less than 25%): 25%

DOAS Human Resources Administration 2 Revised 10/2012

Section 1: Overall Comments:

Section 2: Individual Goals (Weighting can range from 0% to 75% of total score)

Comments Rating
Goal 1: 1% maybe recommended for a person who develops a Valuable Community David Gainous- Director Chamber of Commerce of Cairo. Courtney,
Connection-Organizational Connection or Person Connection. Definition of assistant to Director to Chamber of Cairo.
valuable: Both Connections must present with true opportunities for relationship
building to occur.

Goal 2: 1% maybe recommended for a person who will choose a person to mentor. You Started mentoring Heather Crew - trying to get her comfortable when
recognize the potential in a team member and you believe youhave the skill set, state reps or Support Coordinators come into the building when
talent or gift to assist that person in developing in those identified areas that questioning regarding the individuals. Margaret & Heather was
unable to finish the mentorship b/c Heather resigned from TGSC.
prevent them from performing their job at their best. (Success is based on the
efforts you put forth to mentor a person). The person success is based on evidence
that they are choosing to utilize the K/S/A's gained). As you work in an identified 3
department and is expected to support one another in this manner, you may not
choose someone that you currently work in the same department with except for
the following exceptions: people who work off campus-residential, cairo day hab
program and supported employment will not be expected to choose people outside
of their department.

Goal 3: Continue with more Leadership Training to promote growth FY 19-20

0

Goal 4:

Goal 5:

DOAS Human Resources Administration 3 Revised 10/2012

Note: Calculate the overall section rating by adding the ratings for the individual items in the Overall Section Rating:
section, and then by dividing that total by the number of items in the section. 4.0
Section Weight: 50%
Section 2: Overall Comments:

DOAS Human Resources Administration 4 Revised 10/2012

Section 3 – Job Responsibilities (Weighting can range from 0% to 75% of total score)

Comments Rating
Job Responsibility 1: Provide Direct Well-Designed Training that present opportunities Areas of Focus- pay close attention to PA's that have come out for
for the Participants to have a Valuable Day: (1). Actively involve new ISP to make sure units are being correctly covered wkly/mnthly.
Individual's in training or leisure activities during scheduled times and Make sure that support staff are documenting progress of the
individual that the goal is being worked on at the 3, 6, 12 month mark
training must be reflective of the person's Individualized Service Plan
and successes are being praised and logged and reported to the
(ISP); (2). Monitor Individual's progress daily during training and note support coordinator when they come in for their quarterly visits. Great
specifics relative to progress (improvement, tolerence, enjoyment, at coming up with what is age-appropriate events that individuals can
body language, and verbal expressions); (3). Impliment Proactive be interested in. Always shows diginity and respect to clients. Does a
Measures to Promote Positive Behaviors (presenting options and great job in looking over wkly notes and making sure that they are
activities that interest the person) and Interact with Individuals using person-centered and in line with ISP goals. ****Continue to learn
Only Positive Reinforcement (Reward Good Behavior & Ignore Bad about IDD Connect and putting goals into Therap, taking a look
at PA's to make sure that units adjustments have been made so 4
Behavior); (4). Use age-appropriate interaction designed to promote
dignity, respect and independence; (5). Develop weekly Lesson staff can be made aware.
Plans and use as a guide for daily lessons and make available when
request is made to see how Individuals have been engaged and (6).
Provide training room supervision at all times to ensure participants
safety (0 tolerance of neglect). (Report All Progress to
Supervisor).

Job Responsibility 2: Complete Documentation of Assigned Individual's accurately Makes sure that reports are completed timely and according to policy
and in a timely manner (according to policy and procedure): (1). guidelines. Can improve with making sure all paperwork is more
Document using appropriate instruments/forms (Seizure, Behavior, organized and in correct spot, making sure all new ISP's are printed
and put into person-centered books in house, infoming assigned staff
Fluid and Bowel Elimination, Incidents, Attendance, Observation and
of all individuals that have BSP plans a document when behaviors
Progress Report); (2). Record all units accurately; (3). Document happen so they are logged accordingly. Areas of Focus- improving in
progress of all assigned individuals including (increase or decrease in documenting incidents, discovery of bruising & behaviors in a timely
progress, body language and verbal expressions); and (4). 4
manner. (Placing in Therap or Log Books kept in-house/ Daily
Knowledgeable of all Instruments/Forms and their location. (Report Seizure Logs for those that have Seizure D/O & BSP). Progress
All Progress to Supervisor). notes tell about the individual being person-centered and shows
progress of the individual when successes are being met.

Job Responsibility 3: Lead Unit Monitor: (1). Review all Progress Reports to check Does well in giving Day Hab feedback over the daily operation of
accuracy of units; (2). Tally all units and report results to supervisor. what goes on or if there were any emergencies. Great
Communicator! Does well in communicating with other agencies that
work with TGSC and have individuals attend Cairo site, very good
about informing supervisor if there is an issue with health & safety. 5

DOAS Human Resources Administration 5 Revised 10/2012

Job Responsibility 4: Assure health and welfare of individual served at all times: Helps monitor to make sure that individuals attending the day
(1)Personal Care—Helps consumers with eating, grooming, program are taking care of by doing instructional trainings that
dressing, bathing, and toileting; assists Individuals with their mobility promote independence. Monitors changes within individuals if there is
a behavioral change, physically change, knows their baseline of level
including lifting them from a seated or lying down position, helping
of functioning.
them walk and maintain stability; (2)Operational Support—
Maintains cleanliness of program; drives company vehicle to
transport Individuals to their activities; completes tasks that are
beyond the Individual’s abilities; follows policies and procedures for
handling money. (3). Stay Abreast of Client Progress - Recognize
and communicate any environmental changes or unusual
5
occurrences; Recognize and address an incident or problem behavior
that requires intervention; Familiarize themselves with each
consumer’s standard lifestyle and baseline level of functioning;
Continually assess a consumer’s status and needs; Follow program
procedures in addressing unusual occurrences and problem
behaviors; and Document all findings in program records. (Report
All Progress to Supervisor).

Job Responsibility 5: Daily Direct Support Client Supervisory tasks1) Supervising Does a wonderful job in completing the daily duties of supervising
assigned staff designated by DH Director. 2) Coordinating with Day staff within the Cairo site. Does an excellent job of giving coverage
Hab Director in taking AL. 3) Making sure that HRST trainings are when staff are out, willing to jump right in and help with staff/client
ratio as well as helping with lunch time.
completed 30 days after individuals birthday that are assigned to
caseload. 4)Working with Day Hab Director to resolve conflicts that 5
effect daily operation. 5) Collaborate with staff to ensure UB & Fri
lunch are being rotated amongst staff on a monthly calendar

Cont. 6) Ensuring that classroom training ratio is balanced among

staff within training classroom. 7) Make documentation in the event
that a write up needs to be completed on assigned staff for infraction.
8) Ensuring that assigned staff give adaquate time frame to request
time off. 9) Help staff monitor and document displayed behaviors from
those individuals that have BSP & those individuals that may need
one. 10) Ensure supervisor's assigned staff that weekly timesheets
are filled out properly using the correct leave.

DOAS Human Resources Administration 6 Revised 10/2012

Note: Calculate the overall section rating by adding the ratings for the individual items in the Overall Section Rating:
section, and then by dividing that total by the number of items in the section. 4.6
Section Weight: 25%
Section 3: Overall Comments:

DOAS Human Resources Administration 7 Revised 10/2012

Section 4: Employee Comments

Section 5: Manager Comments

Great job throughout this PMF period. Continue to keep up the awesome work! Thank you!

Section 6: Overall Rating

Section 1 Rating: 4.3 Section 1 Weighting: 25% Weighted Rating Section 1: 1.1
Section 2 Rating: 4.0 Section 2 Weighting: 50% Weighted Rating Section 2: 2.0
Section 3 Rating: 4.6 Section 3 Weighting: 25% Weighted Rating Section 3: 1.2
Note: Calculate the overall rating by multiplying the ratings for each section by the weighting OVERALL RATING:
for each section. This will give you the weighted ratings for each section. Add the weighted 4.2
ratings together for the overall rating.

Key Accomplishments for Review Period

Section 7 - Individual Development Plan (not rated or weighted)

Comments
Development Action 1:

Development Action 2:

Development Action 3:

Development Action 4:

Development Action 5:

DOAS Human Resources Administration 8 Revised 10/2012

Signatures

Employee Signature: Date:

Supervisor/Manager: Date:

Reviewing Manager: Date:

DOAS Human Resources Administration 9 Revised 10/2012

Which sections will you be using?
All Sections (1, 2 and 3)
Sections 1 and 2
Sections 1 and 3