EXEMPT PERFORMANCE EVALUATION AND PLAN

Exempt Employee Performance Evaluation and Planning Form

Employee:Title:

Evaluator:Title:

Division/Department:Date:

Evaluation Period: From toAnnual Other(specify)

Part I. Job Success Factors

U:Unsatisfactory, I: Improvement Needed,M:Meets Expectations; E:Exceeds Expectations; X: Exceptional

Factors RatingComments

A. KEY COMPETENCIES AND RESPONSIBILITIES SPECIFIC TO THIS JOB OR WORK UNIT / U / I / M / E / X
Performs key responsibilities as articulated in the job description. Please review current job description, responsibilities and qualifications with employee. Contact Human Resources to recommend appropriate changes.
B. CORE COMPETENCIES
1. Inclusiveness
Shows respect for people and their differences; promotes fairness and equity; engages the talents, experiences and capabilities of others; fosters a sense of belonging; works to understand the perspectives of others; creates opportunities for access and success.
2. Managing people
Coaches, evaluates, develops, inspires; sets expectations; recognizes achievements; manages conflict; aligns performance goals with agency and division/department goals, provides feedback and leadership; delegates.
3. Stewardship and managing resources
Implements a process or takes action thatresponsibly controls costs, conserves resources and reduces risk to the agency.
4. Problem solving / Decision Making
Identifies problems, involves others in seeking solutions; Conducts appropriate analyses, searches for best solutions and responds quickly to new challenges. Distinguishes relevant information; Makes clear, consistent, transparent, timely decisions; Acts with integrity in all decision making.
5. Strategic planning and organizing
Understands big picture and aligns priorities with broader goals, measures outcomes, uses feedback to redirect as needed, evaluates alternatives, solutions oriented, seeks alternatives and broad input; can see connections within complex issues.
6. Communication
Connects with peers, subordinates, supervisor, persons served, external contacts. Demonstrates effective oral and written communication skills. Actively listens, clearly and effectively shares information.
7. Quality improvement
Strives for efficient, effective, high quality performance in self and the unit; delivers timely and accurate results; resilient when responding to situations that are not going well; takes initiative to make improvements.
8. Leadership
Motivates others, accepts responsibility; develops trust and credibility; expects honest and ethical behavior of self and others.
9. Teamwork
Encourages cooperation and collaboration; builds effective teams; works in partnership with others; is flexible.
10. Service focus
Values the importance of delivering high quality service to internal and external clients; understands the needs of the client; customer service focus.

Part II. Last Period’s Goals

Rate the progress made on each of the goals established at the beginning of the period and any new goals. Note any modifications to the original goals. Note Critical goals (those identified as a priority) with a C.

GoalRatingComments

U / I / M / E / X
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OVERALL RATING (based on Parts I and II) / U / I / M / E / X
Relative weights of job success factors and performance goals are determined in advance by the manager or supervisor and communicated to employee being evaluated. A Performance Improvement Plan, including timelines, shall be developed and monitored for employees whose overall rating is N (Need Improvement) or U (Unsatisfactory) and performance shall be reevaluated in six (6) and three (3) months respectively. Employees with three (3) successive N (Needs Improvement) ratings or two (2) successive U (Unsatisfactory) ratings may be subject to employment termination.

PERFORMANCE SUMMARY (Narrative)

Part III. Next Period’s SMART Goals

Enter the performance goals for the next period to be evaluated. Individual goals and objectives should align with those of the agency, division or department. Note Critical goals (those identified as a priority) with a C. SMART goals are those which are Specific, Measurable, Attainable, Relevantand Timely.

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Measure of success:
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Measure of success:
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Measure of success:
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Measure of success:
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Measure of success:

Progress toward meeting these goals will be reviewed periodically throughout the evaluation period and evaluated at the time of the next evaluation.

Part IV. Professional Development Plan

Part V. Employee Comments

SignaturesEmployee:______Date: ______

(My signature indicates that I have received a copy of this evaluation, including all additional pages, if any, and that it has been discussed with me.)

Manager/supervisor:Name:

Signature: ______Date: ______

Next Level Manager: Name:

Signature: ______Date: ______

The employee being evaluated receives a copy of the completed evaluation and the original is sent to Human Resources.