FAA Student Coaching and Feedback FormDate of Incident Time of Incident Current Date

Supervisor's Name Supervisor's Signature

Employee's Name Employees Signature (if applicable):

Event being documented and coaching follow up:

This form is meant to serve as a record of a conversation with the supervisor and then employee, and does not represent a formal disciplinary action. After being recorded on this sheet, it should be submitted via email to FAA Student Human Resources.

FAA Student Employee Disciplinary FormProgressive Discipline Process 1. Verbal Counseling is issued for minor infractions.2. Written Counseling is issued after previously issuing a Verbal Counseling for a related infraction, or for those

infractions of a more serious nature.3. Steps 1-3 are issued if a Written Counseling or previous Step has been issued for similar infractions or for a first

offense of a more serious nature. If a step is issued the employee and their supervisor should reviewrecommendations for improvement along with actions to be taken and future consequences.

4. Termination can be issued once an employee reaches Step 4 within a 12 month period, if the employee hasn't madesignificant and/or satisfactory improvement or the infraction is of a grave nature.

Please carefully read and follow these instructions:

Before filling out this form, it is highly recommended that you review the employee's electronic p-file by setting up an appointment in the FAA Student Human Resources office (located in NWQ 2420). Forms must be completed, approved and given to the employee within two weeks of the occurrence in question. If this is a Written Counseling or Steps 1-3 please proceed to Disciplinary Actions section of this form. If this is suspension or Step 4 please proceed to the Suspension and Termination Guidelines section of this form.

Disciplinary Actions Fill out all areas of this form completely and precisely.

a. Before meeting with the employee you must have the form approved by FAA Student Human Resources, this can be done via e-mail.

-if a Student Supervisor is completing this form the area's full time supervisor's approval is also needed b. Meet with the student, explain the incident, the importance of proper behavior, and further consequences.c. After the employee signs the form, e-mail it the FAA Student Human Resources to be filed in a timely manner.

Suspension and Termination Guidelines Fill out all areas of this form completely and precisely.

a. Before completing the form and meeting with the employee you must schedule a meeting with FAA Student Human Resources to discuss next steps, and prep for the suspension or termination of the employee.

b. After the meeting with FAA Student Human Resources and the appropriate supervisors we will schedule the next available time with the student to review the discipline and follow through with the decided actions.

Disciplinary Forgiveness Should an employee go a 12 month period without receiving a disciplinary step, that employee's previous infractions may be forgiven. However, should that employee incur a related infractions after the disciplinary forgiveness has been granted, the department reserves the right to issue further disciplinary action, up to and including termination.

Employee Name Empl ID

Full Time Supervisor Name Sup Empl ID

Supervisor Competing Form (if different)

Date of Incident Current Date

FAA HR Approver Name HR Empl ID

Action Taken

*Please discuss suspensions and terminations with FAA Student Human Resources prior to completing this form

Written Counseling

Step 1

Step 2

Step 3

Suspension* (See above.)

Termination* (See above.)

Disciplinary Forgiveness (Go to Disciplinary Forgiveness section.)

Reason for Counseling:

Recommendation for Improvement:

Future Consequences:

Disciplinary Forgiveness

Explanation of Disciplinary Forgiveness: Conditions of Disciplinary Forgiveness:

I understand this employee Corrective Action

FAA Supervisor

FAA Full Time Supervisor (if different)

FAA Student Human Resources HR

Employee

Employee Comments/Remarks:

Employee Note: Failure to improve conduct and/or further violation of policy will result in additional disciplinary action, up to and including discharge. Signing this counseling form does not indicate your agreement with this record but indicates that you have reviewed the content.

FAA Student Employee Exit InterviewWho is filling out this form: Department: Date:

Exiting Employee Name: Exiting Employee Empl ID: Exit Date:

This section is to be completed by the exiting employee (if applicable)

Why are you leaving FAA?

Graduation (please go to question 3)Other (Please Specify):___________________________

Are there circumstances that would have prevented your departure?

YesNo

If yes, please explain:

What did you like most about your job?

What did you like least about your job?

Was your workload usually:

Too HeavyAbout RightToo Little

Was the work you were performing within the duties outlined in your job description?

YesNo

Comments?

Would you recommend FAA to a friend as a good organization to work for?

Most definitelyWith reservationsNo

What suggestions do you have to make FAA a better place to work?

Please rate your supervisor on the following points:

Almost Always

Usually Sometimes Never

Was consistently fair

Provided recognition

Resolved complaints

Was sensitive to employee needs

Provided feedback on performance

Was receptive to open communication

Followed UWM/FAA policies

How would you rate the following:

Excellent Good Fair Poor

Cooperation within your department

Interdepartmental cooperation

Personal job training

Performance evaluations

Rate of pay for your job

Career development opportunities

Physical working conditions

IMPORTANT: MUST READ BEFORE FILLING OUT! Directions: After the employee completes the first section of the exit interview, please answer the following questions privately; do not complete this form in front o the exiting employee. When finished, please submit the entire completed for to FAA Student Human Resources via email.

How did your experience and interactions with this employee help you grow as a supervisor?

Did the employee have attendance or insubordination issues while working for FAA?

Yes No

If yes, please explain:

How would your rate the overall job performance of this employee?

PoorBelow Average FairAverageAbove Average

Would you recommend that this employee be rehired with FAA?

YesNo

Please explain your answer:

FAA Student Employee Change FormTo aid in coordinating student personnel among the departments, FAA Student Human Resources asks that Supervisors within FAA complete this form when you feel a student in your department’s position or pay rate should be modified. The employee may not start the new position or pay rate until after the supervisor receives approval from FAA Student Human Resources. Upon receiving this form FAA Student Human Resources will review the students Personnel File to determine that modification is correct. Complete the following information for an internal move, additional position, pay rate change or promotion:

Employee Name Employee Login

Employee Empl ID Date

Employee's Current Job Title Employee's Current Department

Employee's Supervisor Name/Empl ID Expected End Date

Employee's Current Level:

Beginning ($7.25-10.60)Intermediate ($9.50-12.70)Advanced ($11.60-14.50)

Reason For Movement

FAA Department ChangeAdditional PositionPay Rate Change without PromotionPromotion

Employee's NEW Position (if applicable) Employee's NEW Department (if applicable)

New Dept. ID New Funding Code New Program #

NEW Supervisor / Emlp ID (if applicable) NEW Backup Supervisor / Emlp ID (if applicable)

Employee's NEW Level (if applicable):

Beginning ($7.25-10.60)Intermediate ($9.50-12.70)Advanced ($11.60-14.50)

Employee's New Pay Rate Expected Start Date

Position Description Attached?

YesNo, FAA Student HR has one one fileNo, this is a pay rate change without a promotion (please see below)

If this is a pay rate change without a promotion, please clearly state the reason(s) for this request:

State of Wisconsin EMPLOYEE’S WORK University Of Wisconsin System UW- INJURY AND ILLNESS REPORT UWS/OSLP-1Emp (03/02)

PLEASE TYPE OR PRINT FOR AGENCY USE ONLY Claim Number INSTRUCTIONS: 1. Complete within 24 hours of the injury. 2. Sign and date the completed report Claim Examiner / Representative 3. Submit to your supervisor to complete the WKC-12 form. 4. Direct any questions to your agency Worker’s Compensation Coordinator. Employee Name (as it appears on payroll)

Time of Injury

AM PM

Date of Injury

Work Telephone ( )

Home Telephone ( )

Social Security Number *

Was Medical Treatment Required? First aid only Time Lost From Work

Yes Yes Yes

No No No

Name and Address of Treating Practitioner/Facility

Last day worked (MM / DD/ YY)

Exact location of where accident took place (inside, outside, building name, room, vehicle, etc.) Witnesses (names, addresses, work telephone numbers) Describe in detail what you were doing when the injury /illness occurred. How exactly did it happen?

Date the injury / illness reported to my supervisor (Month, Day, Year) Part of body injured (Check ALL that apply, and circle appropriate position) (Thumb = Finger 1, Great toe = Toe 1) Abdomen Back U M L Finger R L 1 2 3 4 5 Head Mouth Shoulder R L Ankle R L Eye R L Foot R L Knee R L Neck Toe R L 1 2 3 4 5 Arm R L Elbow R L Hand R L Leg R L Nose Wrist R L Other (Please specify) For Hand and Arm injuries circle your dominant arm : Right Left Have you ever been treated for a similar injury or condition?

If Yes Date(s) of Treatment Name of Practitioner, Hospital or Clinic Which Provided Prior Treatment for Similar Injury:

Yes No

Please read carefully. I certify that the above statements are true and accurate and I understand that a false worker’s compensation claim is a violation of Wisconsin criminal code, which may result in a fine, imprisonment, or termination from employment. Further I understand that the signature below authorizes medical, mental health and chiropractic providers to release all medical, mental health and chiropractic records to the State of Wisconsin, University Of Wisconsin System, Office of Safety and Loss Prevention, Worker’s Compensation Department, or its designated representatives, at P.O. Box 8010, Madison, WI 53708-8010 Employee Signature ________________________________________________________ Date ____________________________

FOR PRIMARY ORGANIZATION CODE FUND NUMBER

%

AGENCY 1 -2 8 5 - 0 ___ - ___ ___ - ___ ___ ___ ___ ___ ___ ___

USE SECONDARY ORGANIZATION CODE FUND NUMBER

%

ONLY 1 -2 8 5 - 0 ___ - ___ ___ - ___ ___ ___ ___ ___ ___ ___ LOSS DESCRIPTION CAUSE / OCCURRENCE OBJECT RESULT LOCATION OCCUPATION

CODES ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ OSHA CODES Incident was OSHA "recordable"? Yes No Name of Authorized Representative

Date

*Your Social Security Number must be provided and will be used for positive identification in the processing of any claims.

FAA Student Employee RISE Evaluation

Employee Name Employee Position Title

Supervisor Name Supervisor Position Title

Department Evaluation Review Date

Current Pay Rate

Current Level

BeginningIntermediateAdvanced

Reflect and Inquire

The purpose of the Reflect and Inquire discussion is intended for you and your supervisor to recall and communicate positive or negative actions that took place during the semester as well as relate the skills you have been developing at your job to your personal life and future career.

1) Can you give me a few of examples of things you've learned here that you think you'll use in your chosen profession?

2) How does your experience as a student employee connect with your coursework or you major?

3) What skills have you gained? How would use these in the future?

Suggest

The purpose of the Suggest discussion is to review your performance of your duties and responsibilities throughout the semester as it pertains to your current position description. You and your supervisor will each fill an evaluation out and discuss any areas of improvement for the next semester.

Supervisor Assessment Performance Rating (to be completed by Supervisor)

Exceeds Standards (E)

Meets Standards (S) Needs Improvement (N)

Initiative

Quality of Work

Job Knowledge

Rate of Learning

Adaptability

Judgement

Dependability

Attendance

Overall Rating

Employee Self Assessment Performance Rating (to be completed by Employee)

Exceeds Standards (E)

Meets Standards (S) Needs Improvement (N)

Initiative

Quality of Work

Job Knowledge

Rate of Learning

Adaptability

Judgement

Dependability

Attendance

Overall Rating

Elevate

The purpose of the Elevate discussion is to help you as an employee better understand your current place within the organization and where you would like to expand your knowledge, skills, and abilities during the upcoming semester. To help you better expand your knowledge base and opportunities for advancement within FAA, please discuss with your supervisor your plans and goals for the next semester based on the following three categories:

Training:

Special Projects:

Goals and Opportunities for Advancement:

Please provide feedback on the performance of your employee and fulfilling their duties and responsibilities throughout the semester as it pertains to their Position Description. Include as many details in your comments as possible. Verify comments by including documented cases throughout the semester, as well as all dialogues with the employee, work notes you have taken, or any extra material that may aide in your assessment. Note: It is implied that you have full knowledge of the job duties, performance standards and expectations listed within the Position Description for your employee. You may want to complete this section with a copy of the Position Description in front of you to aide in your comments.

Supervisor Feedback:

Employee Comments: