Agriculture Law and Management


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Responsibility Review



Sample Format for a Responsibility Review

Responsibility review for period from __ to __.
Employee name:
Employee ID number:
Position Title:
Mission of business:
Purpose of position:


Responsibility #_ (repeat as necessary)
Statement of responsibility or duty:
Review of performance and feedback:
Future goals for fulfilling responsibility:
Resources needed to achieve goals:

Consider an explicit review of the responsibility to work safely; also an explicit review of the responsibility to attend training or development.



Supervisor comments:
Employee comments (to be added after the supervisor's comments have been prepared and discussed with the employee):

Note that a responsibility review can be a multi-step process involving both written and oral communication.


Signature of employee and date

Consider a statement above the employee signature such as "My signature below signifies that I have read this review to be placed in my official personnel file and does not necessarily signify agreement. I understand that I have the right to respond in writing to any material in this review and that my response will be attached to this record."

Signature of supervisor and date


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