COLORADO SCHOOL OF MINES
Performance Dispute Resolution Form
(If this form is not applicable, please discard.)

Date____________________________
Employee’s Name_________________________ Job Title________________________________
Department ______________________________ Supervisor______________________________

I wish to have the following reviewed:

_____ 1. My performance plan or lack of a plan. The error or problem is:




_____ 2. My individual performance evaluation. The error or problem is:




_____ 3. The application of the CSM Performance Management plan, process, or policies to my plan or evaluation.
The error or problem is:



_____ 4. Full payment of my award. The error or problem is:




To resolve this issue, I have taken the following actions:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
RESOLUTION BEING REQUESTED:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

Employee’s Signature:_________________________________ Date: ______________
For additional information, consult your supervisor or the Office of Human Resources. Submit copies to your supervisor, the
reviewer (next level supervisor), and to the Human Resource Department.