Build a Professional Development Plan for yourself, focused on your selected competency

Supervisor’s Professional Development Plan

Name: ________________________________________ Date: __________

Foundation area/Performance Domain: _______________________________________________________________________________________

Competency to be addressed and page number from TAP 21-A: ____________________________________________________________________

Strengths: _______________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Challenges/Concerns: _____________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Present level of proficiency from rating forms

1 2 3 4

Level of proficiency to be achieved with this learning plan

1 2 3 4

Target date to complete the plan:

What is the issue to

be addressed?

Goal

What is to be accomplished?

(measurable/behavioral)

Activities necessary to

achieve the goal

What will be done?

Metrics

How will progress be measured? Target Completion Date

Knowledge:

Skill:

Attitude:

Additional comments: _____________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Supervisor signature: _____________________________________________ Date (signed): _________________________________

Date for "re-observation" to assess performance: ____________________________

Results:

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

1. Name:
2. Date:
3. Foundation areaPerformance Domain:
4. Competency to be addressed and page number from TAP 21A:
5. Strengths 1:
6. Strengths 2:
7. ChallengesConcerns 1:
8. ChallengesConcerns 2:
9. Target date to complete the plan:
10. What is the issue to be addressed:
11. Goal What is to be accomplished measurablebehavioralKnowledge:
12. Activities necessary to achieve the goal What will be doneKnowledge:
13. Metrics How will progress be measuredKnowledge:
14. Target Completion DateKnowledge:
15. Goal What is to be accomplished measurablebehavioralSkill:
16. Activities necessary to achieve the goal What will be doneSkill:
17. Metrics How will progress be measuredSkill:
18. Target Completion DateSkill:
19. Goal What is to be accomplished measurablebehavioralAttitude:
20. Activities necessary to achieve the goal What will be doneAttitude:
21. Metrics How will progress be measuredAttitude:
22. Target Completion DateAttitude:
23. Additional comments 1:
24. Additional comments 2:
25. Additional comments 3:
26. Date signed:
27. Date for reobservation to assess performance:
28. 1:
29. 2:
30. 3:
31. 4:
32. 5:
33. 6:
34. 7:
35. 8:
36. 9:
37. 10:
38. 11:
39. 12:
40. Check Box1: Off
41. Check Box2: Off
42. Check Box3: Off
43. Check Box4: Off
44. Check Box5: Off
45. Check Box6: Off
46. Check Box7: Off
47. Check Box8: Off