Department:
Title / Position:
Primary job duties and/or assignments (attach updated job description): / Goals for the next appraisal period:
Accomplishments during current appraisal period: / Coaching, training or development activities that would help you pursue improved performance, job growth and learning:
I have been given the opportunity to fill this out and chose not to do so.
Employee signatureDate(Initial)
PERFORMANCE EVALUATION:The following evaluation is completed by the supervisor based on the employee’s performance over the evaluation period. The employee planning worksheet, established and communicated goals, letters of recognition, coaching and discipline, and other documented, observed and/or communicated performance level shall be taken into account.Performance: / Not
Acceptable / Meets some but not all / Meets Expectations / Exceeds
Expectations / Far Exceeds
Expectations / N/A / Not
Acceptable / Meets some but not all / Meets
Expectations / Exceeds
Expectations / Far Exceeds
Expectations / N/A
1. Job Knowledge / 6. Cooperation
The demonstration of the skills and knowledge required to perform the job. Weigh degree of job knowledge relative to length of service. / Teamwork and flexibility.
Demonstrated support of peers and organizational goals.
2. Quality of Work / 7. Planning and Organizing
The demonstration of accuracy, thoroughness, and reliability. Consider organization, completeness, presentation and appearance of work. / Effectively plans, organizes, and implements tasks/programs. Consider use of time and resources, deadlines, and prioritization.
3. Quantity / 8. Attendance
The demonstration of volume of work, speed, and consistency of output. / Consider punctuality and attendance. Dependability and reliability, communicates schedule changes, etc.
PERFORMANCE EVALUATION continued
Performance: / Not
Acceptable / Meets some but not all / Meets Expectations / Exceeds
Expectations / Far Exceeds
Expectations / N/A / Not
Acceptable / Meets some but not all / Meets
Expectations / Exceeds
Expectations / Far Exceeds
Expectations / N/A
4. Initiative / 9. Other
Individual’s efforts to learn new skills and maintain up-to-date job information. Extent of self-direction, creativity, and resourcefulness.
5. Communication / 10. Other
Effectiveness in conveying and receiving information, ideas, and direction. Willingness to clarify and confirm their understanding of instructions.
OVERALL EVALUATION / Not
Acceptable / Meets some but not all / Meets Expectations / Exceeds
Expectations / Far Exceeds
Expectations / N/A
# of Ratings per Category
PERFORMANCE EVALUATION continued
Primary job duties or assignments (attach updated job description): / Goals, changes or improvements during the next appraisal period:
Accomplishments during current appraisal period:
Comments by supervisor:
Comments by employee:
Employee Name:
Employee Signature:
Date evaluation received: / Evaluator Name:
Evaluator Signature:
Date reviewed with employee:
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