EMPLOYEE PERFORMANCE SUMMARY FORM

INTRODUCTION & INSTRUCTIONS

The Performance Evaluation should include, at minimum, the following items:

  1. Completed Summary Form which must include an overall performance rating
  2. Performance goals and measures for the past and next evaluation period
  3. Review and update of JobDescription with the employee (please attach)

EMPLOYEE NAME (Last, First) / CSI I.D. # / POSITION/JOB TITLE
DEPARTMENT / DATE OF EVALUATION /
EVALUATION PERIOD
From: To:
TYPE OF REVIEW (Check One)
□ 90-Day □ Six-Months □ Annual □ Other ______
SUPERVISOR SUMMARY COMMENTS
The employee in this position meets, or more than meets the CSI Standards of Conduct as well as the other measured areas of performance for the period of review checked above. Professional development and individual goals, past and future, are also noted on this document. / ___ Strongly agree
___ Agree
___ Disagree

REVIEW OF PAST PROFESSIONALGOALS

Objective 1:

Objective 2:

Objective 3:

EMPLOYEE COMMENTS(Attach additional sheet if necessary)

X ______

Supervisor’s SignatureDate

X ______

Next Level Supervisor’s SignaturePlease sign/date prior to employee conference

I am signing this appraisal to indicate that my supervisor and I have had a discussion of the contents.

X ______

Employee’s SignatureDate

Copies to: ___ Employee ____ Supervisor ____ HR Dept. (Original please)

EMPLOYEE PERFORMANCE EVALUATION

RATINGS

Strongly Agree– This employee is very accomplished in all work areas and demonstrates consistently proficient and solid performance in managing work expectations; exhibits sustained support of organizational goals. This employee is effective, consistent, and competent in working and communicating with other employees; may train and guide staff and holds them accountable to meet job expectations and objectives; demonstrates ethical behaviors that result in positive working relationships.

This employee consistently demonstrates significant knowledge, skills, and abilities required to accomplish responsibilities. This employee models a high work ethic. This employee skillfully handles a variety of interpersonal situations. This employee typically performs above expectations in meeting
deadlines, using critical thinking skills, and creativity to accomplish tasks, projects, and objectives. This employee often seeks out additional responsibility. This employee does not need direct supervision.

Agree– This employee meets job expectations. This employee may require more supervision at times, and work may require more revision or adjustment to meet expectations. Assignments are completed but occasionally require assistance from supervisor or peers.

Or, this employee is developing new skills and gaining new knowledge, leading toward performing all expectations and objective of the job. This employee may be new to the position or job duties and may not have completed a full work cycle; this employee is still learning the job. This employee may need time to develop skills to be more proficient in the current position. This employee is cooperative and treats customers, co-workers, and supervisors with respect and courtesy.

Disagree– This employee’s performance or behavior needs improvement and/or is inconsistent or unacceptable. This employee may fail to meet one or more core performance standards and/or key job expectations and has had an identified action plan to ensure progress toward achieving all performance standards. Work previously identified as less than acceptable has not reached the expected level of performance.

CSI STANDARD OF CONDUCT
Describes how well the employee manages follows, supports, champions and models the following College’s Standard of Conduct:
  • Workplace Conduct: Acts fairly, collaboratively, and honestly in personal and group interactions and helps create and maintain a non-discriminatory, harassment free, drug/alcohol free, and respectful workplace. Maintains confidentiality, including protecting the privacy of, and access to, records.
  • Compliance: Understands and adheres to State and Federal laws and rules as well as complying with College policies and other forms of guidance. Usesacceptable processes (College policies and procedures, chain of command, etc.) to bring issues to administration’s attention.
  • Financial Stewardship: Insures accurate financial transactions and reports and maintenance of internal controls. Utilizes College resources in an effective manner, identifies, discloses, and avoids potential conflict of interest, and reports waste, fraud and/or abuse.
  • Individual Responsibility and Accountability: Demonstrates sound judgment, accepts responsibility, and holds himself/herself accountable for meetingthe highest standards of service as well as established performance standards and developmental objectives.
/ ___ Strongly agree
___ Agree
___ Disagree
___ Strongly agree
___ Agree
___ Disagree
___ Strongly agree
___ Agree
___ Disagree
___ Strongly agree
___ Agree
___ Disagree
Comments
CUSTOMER SERVICE
The employee works well with internal and external customers to achieve desired results and maintain positive customer relationships and professional image. Employee expected to be polite and efficient in working with customers. /
___ Strongly agree
___ Agree
___ Disagree
Comments
INTERPERSONAL SKILLS
This employee establishes and maintains effective work relationships. Demonstrates sensitivity to others and has good communication and listening skills. / ___ Strongly agree
___ Agree
___ Disagree
Comments
DEPENDABILITY
The employee completes assigned work in a timely manner, keeps commitments, and is accountable and stays balanced under pressure. The employee meets attendance requirements. / ___ Strongly agree
___ Agree
___ Disagree
Comments
ADAPTABILITY/FLEXIBILITY
This employee adapts to change and is open to different new ways of doing things. Demonstrates willingness to learn and apply new skills or methods in completing work assignments or projects. / ___ Strongly agree
___ Agree
___ Disagree
Comments
TECHNICAL DUTIES
The employee performs the technical duties related to his/her position very well (including department-specific requirements). / ___ Strongly agree
___ Agree
___ Disagree
Comments
QUALITY
Describes the employee's work in terms of consistency, thoroughness, and accuracy. The employee supports and participates in continuous improvement in work processes, services or products. Demonstrates ethical dealings, effective problem-solving skills and meets quality standards set by supervisor. / ___ Strongly agree
___ Agree
___ Disagree
Comments
PRODUCTIVITY
Describes how the employee manages and completes workload expectations by setting and following priorities, using time effectively and achieving work goals. The employee demonstrates the knowledge and skills needed to do the job.
/ ___ Strongly agree
___ Agree
___ Disagree
Comments
WORK ENVIRONMENT/SAFETY
This employee promotes and supports a respectful workplace. Demonstrates support and compliance with general conditions of employment, EEO, security, and workplace safety policies. Demonstrates ethical behaviors, sound decision-making skills, and compliance with appropriate laws and College policies and procedures. / ___ Strongly agree
___ Agree
___ Disagree
Comments
EMPLOYEE DEVELOPMENT
List professional development, workshops, organizations and training in the comments section below.
Comments

NEXT REVIEW PERIOD PROFESSIONAL GOALS:

Establish specific, measurable, attainable goalsto meet new and better ways to carry out job duties.

Summary of goal 1:

  1. How will you do it?
  2. Resources needed?
  3. Expected result?

Summary of goal 2:

  1. How will you do it?
  2. Resources needed?
  3. Expected result?

Summary of goal 3:

  1. How will you do it?
  2. Resources needed?
  3. Expected result?

Rev: 11/17Personal and Confidential