6109.13,31.18,Ex. 01 Page 1 of 3 FOREST SERVICE HANDBOOK WASHINGTON FSH 6109.13 - PERFORMANCE, TRAINING, AND AWARDS HANDBOOK Amendment No. 6109.13-92-4 Effective March 26, 1992 POSTING NOTICE. Amendments are numbered consecutively by Handbook number and calendar year. Post by document name. Remove entire document and replace with this amendment. Retain this transmittal as the first page of this document. The last amendment to this Handbook was Amendment 6109.13-92-3 to 6109.13,31,Ex. 01. Superseded New Page Code (Number of Pages) 6109.13,31.18,Ex. 01 - 3 Digest: 31.18 - Exhibit 01 - Creates the exhibit as a separate document. F. DALE ROBERTSON Chief FSH 6109.13 - PERFORMANCE, TRAINING, AND AWARDS HANDBOOK WO AMENDMENT 6109.13-92-4 EFFECTIVE 3/26/92 31.18 - Exhibit 01 Sample of Form AD-287-2 Showing which blocks to complete for Spot Awards. AD-287-2 10/81) U.S. DEPARTMENT OF AGRICULTURE | 1. AGENCY | 2. AGENCY | 3. CASE NO. | 4. EMPLOYING OFFICE RECOMMENDATION & APPROVAL OF | | CODE | | CODE CASH AWARD OR QUALITY INCREASE |USDA Forest Service | 11 | | **** 5. NAME OF EMPLOYEE (Last, first, MI) OR NAME OF UNIT | 6. SSN | 7. DUTY STATION CODES | **** | State | City | County Employee's name **** | 000-00-0000 | **** | **** | **** 8. PRESENT POSITION & ORGANIZATION | 9. LOCATION (City, State) | 10. OCC SERIES | 11. PAY PLAN-GRADE/ Job title & name of unit **** | **** | **** | STEP: **** 12. PREVIOUS RECOGNITION IN LAST 24 MONTHS (if none "X" here | | ) A. Achievement Award (show date) Amt Rec'd | B. Suggestion Award (show date) Amt Rec'd | C. Q.I. eff date NA | $ NA | NA | $ NA | NA TYPE OF RECOGNITION RECOMMENDED | SPOT | Amount | No. Persons | 17. QUALITY INCREASE S | 13. CASH AWARD AWARD> |$ **** | 1 | A. PERIOD COVERED | B. DATE LAST PROMOTED P | A. SUSTAINED SUPERIOR PERFORMANCE |NA | NA | NA E | (1) Period Covered | (2) Justification | | C | NA | NA | C. DATE OF LAST WITHIN- | D. NEXT WITHIN-GRADE I | (3) Citation | GRADE INCREASE | INCREASE A | | | TO: GRADE/STEP | DUE L | NA | NA | NA | A| | E. PERFORMANCE APPRAISAL (ATTACH COPY) | DATE A W| B. SPECIAL ACT OR SERVICE | X | NA | C A| (1) Period Covered | (2) Justification | F. JUSTIFICATION (Attach statement showing duties H R| Time frame involved | NA | expectations, & how performance exceeded requirements) I D| (3) Citation | G. CITATION E | (THIS IN PLACE OF JUSTIFICATION) | NA V | | E | | M | (4) | (a) Tangible Benefits | | H. CERTIFICATION E | BASIS | First Year Savings -----> If Applicable | I certify that the employee's position description & N | OF CASH | (b) Intangible Benefits **** | | the performance standards for the position were thor- T | AWARD | Degree of Value | Extent of Application | oughly reviewed prior to submission of this recommend- | | Award Scale **** | Award Scale **** | ation; that the employee's performance substantially 31.18 - Exhibit 01--Continued | C. EMPLOYEE SUGGESTION | | exceeded an acceptable level of competence; that the | (1) Summary of Suggestion (attach copy) | performance is characteristic and is expected to con- | | tinue in the future; and that the employee is expected | NA | to remain in the same or a similar position for at S | | least 60 days. U | (2) | (a) Tangible Benefits |NA | (1) RECOMMENDING OFFICIAL (signature & date) G | BASIS | First Year Savings -----> $ | G A| OF CASH | (b) Intangible Benefits |NA | Title: (Staff Director) Date E W| AWARD | Degree of Value | Extent of Application | (2) REVIEWING OFFICIAL (signature & date) S A| | NA | NA | NA T R| D. RECOMMENDING OFFICIAL (signature & date) | Title: NA Date I D| **** | (3) APPROVING OFFICIAL (signature & date) O | Title: Date | NA N | E. REVIEWING OFFICIAL (signature & date) | Title: NA Date | NA | 18. QUALITY INCREASE EFFECTIVE | Title: Date | A. Date | B. TO: (grade & step) | F. APPROVING OFFICIAL (signature & date) | NA | NA | **** | C. New Salary Rate | D. Pay Rate | E. Acct.Sta- | Title: Date | | | Deter. Code | tion Code 14. Cash | (a) Amount Approved -----> $ | NA | NA | NA | NA Award Approved | (b) Number person(s) receiving award | 19. A. | | QUALITY INCREASE NOT APPROPRIATE 15. ACCOUNTING CODE: **** (0's & no.'s = 10 digits)| (give reasons) 16. MAIL CHECK TO: | NA | NA | B. SIGNATURE & DATE NA | | Title: Orig - NFC; cc: OPF; Incentive Awards Coordinator; Obligation Record; & Agency Use