Performance Management Acknowledgement of Extraordinary Contribution

Employee Name:	Employee ID #:	Working Title:
Department:	Position #:	Date of Acknowledgement:

The form documents and acknowledges the extraordinary contributions you have made in the performance of your duties. You are commended for your efforts and for going above and beyond normal work expectations.

Description of specific extraordinary contribution(s):

Supervisor’s Signature:	Date:
Reviewer’s Signature:	Date:
Employee’s Signature:	Date:

Acknowledgment of Extraordinary Contribution Fact Sheet

Purpose of the form:

The Acknowledgment of Extraordinary Contribution is used to recognize and document employee performance that is significantly above and beyond the expected.

When to prepare the form:

The Acknowledgement of Extraordinary Contribution may be completed at any time during the performance cycle and should be completed as close to the occurrence as possible. An acknowledgement of Extraordinary Contribution must be attached to the Annual Performance Evaluation when it is submitted to Human Resources to support an overall rating of Extraordinary Contributor; however, receipt of this acknowledgement does not guarantee such a rating.

Who prepares the form?

The immediate supervisor completes the Acknowledgment of Extraordinary Contribution as close to the occurrence as possible and discusses it with the employee. The form is signed by the supervisor, reviewer and employee.

Presentation of the form:

A copy of the signed Acknowledgment of Extraordinary Contribution is given to the employee.

Retention:

When an Acknowledgment of Extraordinary Contribution is used to support an overall rating of Extraordinary Contributor on the Annual Performance Evaluation, the original form is sent to Human Resources along with the evaluation. The Acknowledgment of Extraordinary Contribution then becomes part of the employee’s personnel file maintained in Human Resources. Otherwise, the form is retained in the department’s files until the annual evaluation is complete.

Whom to Contact:

For more information or clarification, contact your HR Consultant.