TMH Performance Management Program
Program Objectives: Ensure high-quality patient care. Promote professional growth and accountability. Align individual performance with organizational goals. Retain top talent and address underperformance constructively.
Review Quarter
Please Select
Q1 : Jan - Mar
Q2: Apr - Jun
Q3: July - Sept
Q4: Oct - Dec
Employee Name
First Name
Last Name
Supervisor
First Name
Last Name
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Section 1: Core Competencies Evaluation
Rating Scale:1 = Unsatisfactory | 2 = Needs Improvement | 3 = Meets Expectations | 4 = Exceeds Expectations | 5 = Outstanding
Clinical Knowledge
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Therapeutic Techniques
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Assessment & Diagnosis Skills
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Treatment Planning
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Section 1: Overall Score (4-20)
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Section 2: Client Engagement
Rating Scale:1 = Unsatisfactory | 2 = Needs Improvement | 3 = Meets Expectations | 4 = Exceeds Expectations | 5 = Outstanding
Communication with Clients
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Patient Continuum of Care
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Client satisfaction
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Section 2: Overall Score (3-15)
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Section 3: Productivity
Rating Scale:1 = Unsatisfactory | 2 = Needs Improvement | 3 = Meets Expectations | 4 = Exceeds Expectations | 5 = Outstanding
Billing required hours ( 1=Not Meeting, 2=Meeting, 3=Exceeding)
Not Meeting
1
2
Exceeding
3
1 is Not Meeting, 3 is Exceeding
Brief explanation
Documentation completion time
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Accuracy of Documentation
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Section 3: Overall Score (3/13)
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Section 4: Compliance
Rating Scale:1 = Unsatisfactory | 2 = Needs Improvement | 3 = Meets Expectations | 4 = Exceeds Expectations | 5 = Outstanding
Licensing, Training and Certification Compliance
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Section 4: Overall Score (1-5)
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Section 5: Adherence to TMH standards
Rating Scale:1 = Unsatisfactory | 2 = Needs Improvement | 3 = Meets Expectations | 4 = Exceeds Expectations | 5 = Outstanding
Involvement in TMH and community functions
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Communication with Clinical Supervisor
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Adherence to TMH Ethical Standards
Needs Improvement
1
2
3
4
Exceeds Expectations
5
1 is Needs Improvement, 5 is Exceeds Expectations
Brief explanation
Section 5: Overall Score (3-15)
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Section 6: Goals & Professional Development
Previous Period Goals Achieved:
Yes
Partially
No
N/A
Comments on Past Goals:
Goals for Upcoming Review Period:
Training or Certifications Recommended:
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Overall Performance Summary
Overall Performance Score ( 13 Min / 65 Max)
Crisis Intervention
1 = Unsatisfactory
2 = Needs Improvement
3 = Meets Expectations
4 = Exceeds Expectations
5 = Outstanding
Not Applicable
Brief explanation
Strengths:
Areas for Improvement:
Additional Supervisor Comments:
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Should be Empty: