701 A2 Sample Unsatisfactory Performer Evaluation Review Request Memorandum

Date

MEMORANDUM

To: Employee’s Name and Title

From: Supervisor’s Name and Title

Subject: Unsatisfactory Performer Evaluation Review Request

This year, your annual performance evaluation reflects a rating of “1 — Unsatisfactory Performer.” If you believe that the rating you received is arbitrary, capricious, or not reflective of your overall performance, you have the right to request a review of your evaluation. You have five (5) workdays from receipt of your copy of the evaluation to submit a written request for a review to the Designated Review Official named below:

Name/Title

Organizational Unit

Address

City, State, Zip

Upon receipt of your request for review, the Designated Review Official will examine your evaluation and any supporting documentation you provide and may meet with you and/or me, if deemed appropriate. Within 15 workdays of receipt of your request, the Designated Review Official will issue a written response to either uphold the rating or to direct that the evaluation be revised. The Designated Review Official will send the response to you, with copies to me, the Reviewing Manager, and Human Resources.

The decision rendered by the Designated Review Official is final. Issues concerning the performance management process is not grievable.

c: OHR
Personnel File