Performance Evaluation Form

Commissioned (Non-Manager)

If You Are the Employee Being Reviewed

Name:

Job Title:

Department: Evaluation Period: / / through / /

(month/day/year)

If You Are the Reviewer

Name:

Job Title:

Date of Review:

Instructions

  For each category listed on the following page, please assign appropriate ratings (see guidelines below).

  For the employee being reviewed, please complete this form and submit in advance to your manager as part of the self-appraisal process by (date).

  For the reviewer, please complete this form, sign/date (and have the employee sign/date), and return to HR within 30 days of the employee’s review date.

Performance Rating Codes/Guidelines

1 / Unsatisfactory / Below minimum job requirements—meets few, if any, of the minimum job requirements.
2 / Marginal / Meets some requirements, but fails to meet others—meets the requirements more often than not.
3 / Fully Satisfactory / Consistent performance of required job duties. (Indicates that the employee is doing a good job.)
4 / Exceeds Requirements / Normally exceeds what is considered fully satisfactory.
5 / Outstanding / Achieves results of exceptional value—consistently exceeds job requirements. (Indicates that the employee is consistently doing a fantastic job.)

Name of the Employee Being Reviewed:

Performance / Rating Code / Guideline
Customer Service / General description: Handles internal and external customers and difficult situations in a cooperative, courteous, and helpful manner. Exhibits patience with others when trying to solve their needs.
Quality of Work / General description: Work is timely, accurate, and performed to standard. Demonstrates solid knowledge of job/required duties. When not guided by policies/procedures, makes appropriate decisions that are consistent with the job mission.
Dependability / General description: Regularly reports to work on time and maintains a good attendance record. Follows through on assignments as scheduled. Exhibits behaviors that are supporting of the department’s goals.
Communication / General description: Expresses ideas and exchanges information needed to get the job done and listens carefully to co-workers and others. Presents information and directions clearly, effectively, and factually. Responds to communication (e-mail, voicemail, requests for information) in a timely fashion. If in a supervisory role, shares constructive feedback with direct reports as needed.
Teamwork / General description: Works cooperatively with others and contributes to the group with ideas, information, and effort. Contributes to the department’s goals by providing support and cooperation to all staff. Assists team members as needed, without being asked. Considers the good of the Houstonian, not only of the department, in actions.
Decision Making / General description: Resolves problems effectively (in other words, based on facts, rather than emotion) and independently. Employs listening skills, if appropriate, to help make decisions.
Adaptability / General description: Learns new duties, approaches, or routines easily and is open to change in procedures. Responds quickly to changing circumstances, meeting customer expectations.
Safety / General description: Consistently uses appropriate safety equipment for the job (e.g., ladder for climbing, support belt for lifting, etc.) Maintains safe and neat work area and responds appropriately to safety hazards when discovered. Participates in OSHA and safety training.
Accountability / General description: Takes ownership of assignments through to conclusion. Approaches assignments with appropriate levels of urgency. Keeps supervisor apprised of progress/road blocks. Meets deadlines for completion and produces desired results.
Dignity / General description: Treats customers and fellow employees with courtesy and respect at all times. Embraces diversity of employees and culture.
Performance / Rating Code / Guideline
Trustworthiness / General description: Demonstrates integrity in daily interactions and is loyal to those not present (including co-workers and customers). In general, chooses to do the right thing. Demonstrates courage by sharing difficult feedback.
Continuous Improvement / General description: Participates in continuing education. Looks for ways to improve the product/process, if applicable. Takes advantage of training or professional development opportunities offered by the Houstonian, if applicable.
Job-Specific
/ General description: List examples of what it takes to be successful in this job.

List specific examples of strengths and opportunities for improvement demonstrated by this individual over the past year, if applicable.

Strengths:
Areas/Skills to Work on Improving, if applicable:
Plan to Accomplish, if applicable:

Reviewer Signature: Date:

*Employee Signature: Date:

Name of the Employee Being Reviewed:

*The employee signature indicates that the performance evaluation conversation took place, but not necessarily full agreement with the results of the evaluation.

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