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Personal Skills) ⎯ Department or University Rules ⎯ Safety or Work Environment ⎯ Attendance – Dependability ⎯ Customer Service ⎯ Other ________________________ Concern / Issue / Incident Describe performance concern or issue (be specific, and include dates and examples): Describe agreed upon solution(s) or course of action: Note follow-up review plan date(s), etc. Employee’s Signature: Date: Supervisor’s Signature Date: NOTE: Employee’s signature indicates tha.

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