Performance Evaluation Form

Employee Name: / Title: Click here to enter text.
Evaluator Name: Click here to enter text. / Title: Click here to enter text.
Evaluation Date: Click here to enter a date.

Section I: Evaluate Last Year’s Performance Goals

Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Achievement Status: Choose an item. / Performance Rating: Choose an item.
Comments: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Achievement Status: Choose an item. / Performance Rating: Choose an item.
Comments: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Achievement Status: Choose an item. / Performance Rating: Choose an item.
Comments: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Achievement Status: Choose an item. / Performance Rating: Choose an item.
Comments: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Achievement Status: Choose an item. / Performance Rating: Choose an item.
Comments: / Click here to enter text.

Add additional goals as necessary using the Section I additional goals document.

Section II: Evaluate Performance Factors

Instructions: Rate the performance for each of the following factors. Comment section must be completed.

1)  Key Performance Factor: JOB KNOWLEDGE, SKILLS AND ABILITIES

Choose an item. / Demonstrates competence in field or specialty and applies experience, knowledge and skills effectively
Choose an item. / Uses sound judgment in decision making, foresees and evaluates impact of decision in related areas
Choose an item. / Exhibits technical competency and keeps current on the latest concepts, techniques, and methods
Choose an item. / Effectively leverages appropriate technology to improve performance
Choose an item. / Serves constituencies in a respectful and helpful manner to achieve success
Choose an item. / Maintains a high level of productivity consistent with performance and quality standards
Choose an item. / Has knowledge of and complies with applicable laws, regulations, policies, and procedures
Choose an item. / Remains current in field through professional development, research and external organizations
Choose an item. / Displays concern and takes corrective action to enhance safety of work environment
Supporting Comments: / Click here to enter text.

2)  Key Performance Factor: INNOVATIVE THINKING, PLANNING AND IMPLEMENTING

Choose an item. / Adjusts readily to multiple demands, shifting priorities, change and unexpected events
Choose an item. / Anticipates and prevents situations that may have an adverse effect on processes
Choose an item. / Recognizes opportunities, thinks and acts strategically to capitalize on them
Choose an item. / Self-reliant and resourceful, develops solutions and follows through completely
Choose an item. / Manages time well, is dependable with minimal absences and/or tardiness
Choose an item. / Accepts responsibility and ownership for own performance, committed to continued improvement
Choose an item. / Embraces and champions new ideas, alternative methods and enhancements, drives toward goal achievement
Choose an item. / Uses sound judgment to determine when to take action and when to seek guidance and/or assistance
Supporting Comments: / Click here to enter text.

3)  Key Performance Factor: INTERPERSONAL/COMMUNICATIONS

Choose an item. / Leads by example, makes valuable suggestions, contributions are welcomed and valued
Choose an item. / Presents ideas clearly and accurately in writing and speaking
Choose an item. / Listens carefully to others and cooperates with coworkers, models high level interpersonal skills
Choose an item. / Acts as a cohesive member of a team, adds complementary skills and contributes valuable ideas, opinions and feedback
Choose an item. / Effectively facilitates and implements solutions, encourages collaboration
Choose an item. / Has a positive impact on the team dynamics, regularly seeks feedback for the purpose of improving work performance
Choose an item. / Operates with the highest ethics and integrity
Choose an item. / Builds effective working relationships throughout the campus community and with external constituencies
Supporting Comments: / Click here to enter text.

4)  Key Performance Factor: LEADERSHIP/MANAGEMENT

Choose an item. / Embraces and personally connects to the University’s mission, supports the strategic plan initiatives
Choose an item. / Plans and coordinates financial tasks, fiscal priorities and financial issues, including department budget management
Choose an item. / Develops strategies through analyzing strengths/weaknesses, knowledge of the industry and market
Choose an item. / Monitors, evaluates and takes appropriate action to ensure employee(s) meet expected performance levels
Choose an item. / Develops employees through ongoing feedback, coaching, counseling and training
Choose an item. / Achieves positive relations within his/her span of control, models a positive, professional image
Choose an item. / Creates a positive work environment and develops alliances within the University to work toward common goals
Supporting Comments: / Click here to enter text.

Section III: Evaluate Employee Performance (check one)

☐ / Needs Improvement: Employee who inconsistently demonstrates role knowledge and struggles with some of the competencies related to the position. Employee requires more than the expected level of supervision due to work quality or level of learning required to complete role successfully. Employee may have completed one or more of the goals set, however overall performance has not met expectations and needs improvement. A performance plan and additional evaluation of the employee’s performance is required.
☐ / Successful: Employee who regularly meets and sometimes exceeds expectations. Employee met goals set for the year and may have been rated exceptional in several key performance factors. Employee possesses full depth and breadth of knowledge necessary for current position. Employee participates in additional projects as needed. Employee consistently interacts effectively with peers and management and demonstrates initiative and continued work improvement. Most employees perform at this level.
☐ / Exceptional: Employee who significantly and consistently exceeds expectations and role requirements. Employee has exceeded goal expectations set for the year and is exceptional in all key performance factors. Employee demonstrates exceptional depth and breadth of role knowledge, highly recognized within the University community. Employee regularly takes on or is assigned substantial additional tasks critical to the success of a major project or initiative. A relatively small percentage of employees perform at this level consistently.
Supervisor Comments on Employee’s Overall Performance:
Click here to enter text.

Section IV: Plan for the Next Evaluation Cycle (list in order of priority)

Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Measure of Completion: / Click here to enter text.
Resources Necessary: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Measure of Completion: / Click here to enter text.
Resources Necessary: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Measure of Completion: / Click here to enter text.
Resources Necessary: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Measure of Completion: / Click here to enter text.
Resources Necessary: / Click here to enter text.
Goal Type: / Choose an item.
Goal Description: / Click here to enter text.
Measure of Completion: / Click here to enter text.
Resources Necessary: / Click here to enter text.

Add additional goals as necessary using the Section IV additional goals document.

Section V: Signatures and Comments

Supervisor signature: I have completed and discussed this evaluation with the employee.

Click here to enter a date.
Signature / Date
Click here to enter text.
Print Name and Title


Signature of other administrators reviewing form:

Signature / Date
Print Name and Title
Signature / Date
Print Name and Title
Signature / Date
Print Name and Title


Employee signature:

I understand that my signature is required to ascertain that I am aware of the contents of this evaluation and may or may not indicate my agreement with it. I further understand that I may attach comments of my own if I wish. I also understand my evaluation will be reviewed for a possible salary adjustment providing I have completed the required length of employment. I understand the procedure for filing a rebuttal if I disagree with any aspect of this review.

Signature / Date
Print Name and Title
Employee Comments:

Section VI: Update at Mid-Cycle

Conduct a mid-cycle update to record general job performance and to document any adjustments to goals and objectives.

Overall performance at mid-cycle (check one):
☐ / Employee meets performance expectations.
☐ / Employee does not meet expectations and a performance improvement plan has been established in coordination with the Office of Human Resources.
Update on goals at mid-cycle (check one):
☐ / Employee’s goals are on target.
☐ / Employee’s goals need to be adapted, changes are attached. (Changes in objectives need not be documented).
Supervisor Comments:
Click here to enter text.
Supervisor Signature: I have completed and discussed this mid-cycle update with the employee
Click here to enter a date.
Signature / Date
Click here to enter text.
Print Name and Title

Employee Signature:

Signature / Date
Print Name and Title
Employee Comments:

Created 02.02.2010atfPage 1 of 7