HTML Preview Employee Suggestion Evaluation Form Sample page number 1.
U.S. DEPARTMENT OF AGRICULTURE
EMPLOYEE SUGGESTION FORM
$OLUTIONS $AVE
SO $UBMIT $UGGESTIONS
1. CURRENT SITUATION: (Describe the present pr procedure, condition, etc., in full detail.)
2. EXPLAIN YOUR SUGGESTION: INCLUDE SPECIFIC RECOMMENDATIONS FOR CHANGE.
3. I BELIEVE MY SUGGESTION WILL:
5. SUGGESTOR'S NAME (Print or Type)
6. SIGNATURE 7. AGENCY 8. DATE
9. TELEPHONE/FAX:
12. DATE SUGGESTION RECEIVED: 13. RECEIVED BY: 14. TITLE
15. SUGGESTION TRACKING NO.
15A. EVALUATING OFFICE B. RECOMMENDED ACTION (Attach Written Comments) C. SIGNATURE OF EVALUATOR D. TRACKING NO. E. DATE
10. OFFICE MAILING ADDRESS 11. E-MAIL ADDRESS
4. IDENTIFY THE ADVANTAGES AND BENEFITS OF YOUR SUGGESTION INCLUDING THE MEASURABLE OR NONMEASURABLE SAVINGS THAT WOULD RESULT.
SUGGESTOR:
Complete items 1 thru 11.
Please print or type except for signature.
(If you need additional space, attach a seperate sheet of paper.)
Increase Productivity
Prevent Injuries & Illnesses
Increase Service
Improve Quality
Improve Methods
Other (Identify):
Reduce Costs
The acceptance by me of an award for this suggestion shall constitute an agreement that the use of the suggestion by the United States shall not
form the basis of a further claim of any nature upon the United States by me, my heirs, or assigns.
SUGGESTION COORDINATOR (Complete Items 12, 13, 14, 15, and 16A.)
EVALUATING OFFICE
( Complete items 16B, C, D, AND E. Use the Evaluator's Checklist (on reverse) to assist you in evaluating the suggestion.)
Adopt Reject Other:
Adopt Reject Other:
SEE REVERSE SIDE FOR INSTRUCTIONS AND ADDITIONAL INFORMATION.
FORM AD-287 (7/97)
This form was created electronically by National Production Service, Fort Worth, Texas
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