CITY OF ATLANTA: POLICE DEPARTMENT

QPAI

PERFORMANCE APPRAISAL FORM
EMPLOYEE DATA
1. (Name) Last, First, MI	2. Employee #	3. Increment Date (mm/dd)	4. Last Evaluation Date
5. Class Title	6. Class Code	7. Bureau/Division	8. Section	9. Unit
PERFORMANCE PLANNING MEETING
10.Meeting Date (mm/dd/yy)

11. Employee’s Signature	12. Supervisor’s Signature
13. Supervisor’s Supervisor’s Signature, & Date	14.	Select if employee is borrowed personnel	15. QPAI Team Review, Signature, & Date
16. Continuation of QPAI Package Under New Supervisor

(select only if applicable)	16a. Employee’s Signature & Date	16b. Supervisor’s Signature & Date
PERFORMANCE DATA (complete at the end of the evaluation period)
16. Type of Appraisal (select the applicable box or boxes)	17. Performance Period (mm/dd/yy)
Annual	From:
End of evaluation period due to transfer or promotion	To:
Probationary (check only one)
New Hire (nonsworn end of probation)	18. Overall Rating (select only one)
New Police Officer (end of probation)	Outstanding
Promotion (sworn end of probation)	Highly Effective
Final Performance Probation	Effective
Other (Specify):	Unacceptable
CERTIFICATION (complete at the end of the evaluation period)
Supervisor’s certification: I hereby certify that the above information is based on personal knowledge of the employee’s job performance for the time period above.
19. Supervisor’s Name (Last, First, MI)	20. Employee #	21. Title

22. Signature & Date

Employee’s certification: I hereby certify that I have received a copy of this QPAI package, and it has been discussed with me (select or place an “X” in the appropriate box or boxes).
23. I agree with the rating.	I disagree with the rating and request to discuss it with my supervisor’s supervisor (Comment below)
24. Signature & Date

Supervisor’s Supervisor’s certification: I hereby certify that I have reviewed this QPAI package.
25. Supervisor’s Supervisor’s Name (Last, First, MI)	26. Employee #	27. Title
28. Signature & Date
Final review and certification: I hereby certify that I have reviewed this form.
29. Bureau or Division Commander’s Signature & Date	30. Chief of Police’s Signature & Date
APD-801 (Revised) (July 1, 2002)

CITY OF ATLANTA: POLICE DEPARTMENT

QPAI

KEY JOB ELEMENT FORM
1. (Name) Last, First, MI	2. Employee #	3. Date (mm/dd/yy)
4. Bureau/Division	5. Section	6. Unit
7. City Priority

Creating a Safer City
8. Department Objective
To maintain an environment in which citizens, workers and visitors feel safe and secure.

9. Section Objective
Key Job Element #1
Customer and Source:
Performance Indicators:
Key Job Element #2
Customer and Source:
Performance Indicators:
10. Employee’s Signature & Date	11. Supervisor’s Signature & Date
APD-802 (Page 1) (Revised) (July1, 2002)

CITY OF ATLANTA: POLICE DEPARTMENT

QPAI

KEY JOB ELEMENT FORM (Continuation Sheet)
12. (Name) Last, First, MI	13. Employee #	14. Date (mm/dd/yy)
Key Job Element #3
Customer and Source:
Performance Indicators:
Key Job Element #4
Customer and Source:
Performance Indicators:
Key Job Element #5
Customer and Source:
Performance Indicators:
15. Employee’s Signature & Date	16. Supervisor’s Signature & Date
APD-802 (Page 2) (July 1, 2002)

CITY OF ATLANTA: POLICE DEPARTMENT

AJordan

2004-08-04

Atlanta Police Department