Performance Review Work Sheet for Managers

Review periods

Newly Hired after 30 days / Informal Review, Note to Human Resources that a meeting has taken place for placement in personnel file.
Newly Hired after 90 days / Formal Review on Performance Review Form.
Newly Hired after 6 months / Formal Review on Performance Review Form. Review for Merit Increase.
One Year of Employment and every year thereafter / Formal Review on Performance Review Form. Review for Merit Increase.
90 Days in New Position / Formal Review on Performance Review Form.

Instructions

Step 1 / Have employee complete their high lighted portion of the Employee Review. Employee will then return their completed form to the Manager. Same form will be used for Manager to write their review.
Step 2 / Carefully evaluate employee's work performance in relationship to the essential functions of their written job description over the review period. Any alterations to the job description should be made at this time. Review must be written in ink. Manager to enter number of each letter represented on back of sheet.
Step 3 / Human Resource/Admin Team Member will assign a numerical score in order to determine if merit increase is due.
Review with employee only after speaking with Admin Team Member.
Step 4 / Original to be sent to Human Resources for filing in the employee’s personnel file.

Definition of Ratings per Category

RESPONSIVENESS

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Actively listens and asks questions. (No repetitive questions.)

  • Demonstrates positive body language, (eye contact, smile, etc.)
  • Responds to customers’ requests, needs, and expectations in a timely manner including request for changes in department and clinic.

Adaptability - Flexibility to respond to changes in the position, department and clinic. Willing to accept change.

O / Superior ability to grasp new information and varying responsibilities; Always volunteers when short staffed. Role model to others.
E / Readily adaptable and occasionally suggests changes to improve function; Sometimes volunteers to fill vacancies.
A / Generally willing to accept changes in job assignments and to try new methods; Available when short staffed.
N / Some willingness to respond to change, but with reluctance; Sometimes fills in for vacancies.

Communication – Actively listens and asks questions. Demonstrates positive body language.

O / Always listens and engages the customer. Role model to others.
E / Consistent listener. Engages the customer.
A / Usually listens and asks questions. Demonstrates positive body language.
N / Does listen well. Does not ask questions. Demonstrates negative body language.
EXCELLENCE /
  • Places a high value on quality, efficiency and productivity.
  • Strives to be knowledgeable and technically current.
  • Strives to exceed customer expectations.

Quality – The extent to which an employee's work is accurate, thorough, organized, and neat.

O / Result virtually perfect, exceptional accuracy, thoroughness and effectiveness; Rarely needs direction. Role model to others.
E / Work product is of consistent high quality; Requires only minimum direction.
A / Work quality meets acceptable quality standards; Requires some direction.
N / Work frequently below quality standards; Requires frequent direction to improve quality.

Job Knowledge/Technical Skills - The extent to which an employee possesses and demonstrates the practical and technical skills or knowledge required on the job.

O / Seeks additional job knowledge and skills and applies such to the overall improvement of department function. Role model to others.
E / Above average level of knowledge and skills applied to job duties; Functions with minimal supervision.
A / Properly applies skills and knowledge of the techniques, procedures, products and materials to perform job duties.
N / Basic understanding of job duties; Requires frequent direction to apply knowledge/skills properly.

Productivity - The extent to which an employee produces a significant volume of work efficiently in a specified period of time. Adheres to deadlines.

O / Always exceeds job requirements with exceptional speed and volume of work accomplished. Role model to others.
E / Consistently achieves a high volume of work surpassing job requirements.
A / Generally produces a volume of work that meets job standards. Plans and carries out work in a timely manner.
N / Work frequently below quality standards; Requires frequent direction to improve quality.

Continued on back

SENSITIVITY

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Responds with empathy, courtesy, and respect.

  • Generous with genuine and sincere compliments and has the ability to graciously accept compliments.
  • Ensures privacy and dignity of customers.

Patient/Customer Care - The extent to which an employee successfully interacts with patients/customers, makes appropriate care decisions, provides necessary/required care and maintains positive relationship with patients/customers.

O / Exemplary service; Sets example by promoting service to patients and others; Recognized for good service by others; Always considers comfort and ease of others. Role model to others.
E / Consistently exceeds job responsibilities to satisfy patients and others; Is cheerful and friendly with others. Very conscientious of other’s feelings and rights.
A / Readily assists patients and employees to provide good service; Gives priority to satisfying others. Confidentiality is maintained.
N / Occasionally acts in ways which promote good service; Sometimes abrupt or discourteous reflecting poorly on clinic.

PROFESSIONALISM

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Maintains professional appearance and conduct while providing high levels of service competently and consistently.

  • Independently able to handle stressful situations.
  • Maintains a positive attitude and contributes to a positive perception of the team.

Attendance - The extent to which an employee is punctual, observes prescribed work break/meal periods and has an acceptable overall attendance record.

O / Perfect attendance and punctuality; Often prearranges alternate staffing for scheduled time off. Role model to others.
E / Seldom absent; Reports absences early in order that alternate staffing may be arranged.
A / Consistently on time (no more than 12 tardys within a twelve month period. Average attendance (no more than 3 call off occurrences in a 6 month period). See Policy for definitions.
N / Occasionally reports late to work or back from lunch; Higher than average unscheduled absences.

Attitude - The extent to which an employee demonstrates a positive and helpful attitude and communication style when dealing with coworkers, supervisors, subordinates, customers, patients and/or any other outside contact.

O / Outstanding attitude and appearance that demonstrates positive influence to patients, families, co-workers and others. Role model to others.
E / Consistently demonstrates strong interpersonal skills resulting in positive outcomes with patients, families, co-workers and others.
A / Demonstrates appropriate and courteous behavior to patients, families, and co-workers using good acceptable communication skills.
N / Sometimes inappropriate or unprofessional in manner or appearance.
EMPOWERMENT /
  • Utilizes skills to effectively address customer requests, needs, and expectations at the point of service.
  • Follows through on promises.

Judgment - Ability to evaluate situations and make sound decisions. Acts with sensitivity to the needs and concerns of others.

O / Displays exceptional ability to analyze and appropriately response to deal with a variety of situations. Role model to others.
E / Consistently makes appropriate recommendations. Rarely requires assistance.
A / Generally demonstrates logical thinking by making sound decisions after considering available facts.
N / Sometimes makes decisions in haste without using available information; Sometimes fails to seek needed assistance.

Initiative - The extent to which an employee seeks out new assignments, assumes additional duties when necessary, proposes ideas and finds new and better ways of doing things.

O / Always looking for ways to improve work efficiency and quality. Role model to others.
E / Consistently suggests better ways for accomplishing work when appropriate. Does additional work without direction.
A / Knows what needs to be done and does it.
N / Often requires some direction to accomplish work. Seldom performs additional duties.

CUSTOMER DIVERSITY AWARENESS

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Recognizes and adapts to differences in cultures/traditions in all encounters.

  • Demonstrates flexibility to respond to a wide variety of requests and needs.
  • Being aware of who your customers are.

Customer Awareness - Respecting the individual and avoiding discrimination or preferential treatment based on age, appearance, beliefs, culture, disability, life styles, race, religion, sex, or any other differences.

O / Exceptional insight and skill to deal with customer diversity. Role model to others.
E / Consistently recognizes differences, shows acceptance of, and works to maintain the dignity of those differences.
A / Recognizes differences and shows acceptance of.
N / Does not always recognize and anticipates differences and the resulting special needs of those differences.

TEAMWORK

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Recognizes and demonstrates the importance of partnership in teamwork.

  • Actively contributes to the goals of the team. (Team includes all customers.)

Team Work/Cooperation - The extent to which an employee demonstrates the ability to cooperate, work and communicate with coworkers, supervisor, subordinates, customers, patients and/or any other outside contact.

O / Exceptional team player. Role model to others.
E / Consistently contributes to the overall department efforts; Actions complement efforts of other employees.
A / Responds to the overall organizational efforts. Works well in a group.
N / Does not contribute to the overall organizational efforts. Does not work well in a group.

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