PDQ/POSITION DESCRIPTION QUESTIONNAIRE &

EVALUATION/PERFORMANCE MANAGEMENT

FORM

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Position Description Questionnaire
Performance Management Form
Evaluation Type
Conference Date
(OP 70.12) / TTU/TTUHSC
POSITION DESCRIPTION
QUESTIONNAIRE
& STAFF
PERFORMANCE
MANAGEMENT / CLASSIFICATION
Position
Job Class Code
Date

**********POSITION INFORMATION***********

  1. Name:

Social Security #:

Current Education Level:

Date of Hire:

  1. Department:
  1. Campus Address:

Campus Phone:

  1. Name of Immediate Supervisor:

Title of Immediate Supervisor:

**********POSITION DESCRIPTION***********

  1. State the chief purpose or objective of this position in a brief statement.
  1. Describe the major areas of responsibility.
  1. The level of coworker interaction/dependence can be characterized as being: (check one)

Extensive (much direct interaction/dependence on coworkers to accomplish work)

Moderate (some interaction with coworkers to accomplish work)

Limited (work is highly autonomous; little interaction with coworkers necessary to accomplish work.

  1. The level of supervision received (check one)

Extensive (much direct supervision; work with supervisor)

Moderate (access to supervisor and/or lead coworker, when needed)

Limited (worker must be highly autonomous; show much independence)

  1. Describe the amount of and type of supervision given to subordinates. (List number and title of employees supervised)

**********POSITION FUNCTIONS**********

  1. INSTRUCTIONS FOR EMPLOYEE:
  1. Briefly list the functions to be performed and give specific examples of each. State the most important function first and finish with the least important.
  2. Identify how often the function is performed. (Daily, Weekly, Monthly, Annually, Quarterly, Varies).
  3. If daily, identify what percent of each eight hour day is spent performing this function.
  4. Identify what equipment is used to perform each function.
  1. INSTRUCTIONS FOR SUPERVISOR:
  1. Identify the function listed as essential or marginal. The function is essential if the reason the position exists is to perform that function or because the function is highly specialized. Functions of the job that do not meet the criteria for essential functions are marginal functions.
  2. Identify performance standards of each function listed. List the performance standard as a particular level of quality or quantity or other standard under which performance will be measured.
  3. Applicable only when completing staff performance management. Identify performance rating by job function. Narrative comments are required for ratings of 1, 2, or 5.

1 – Unsatisfactory4 – Exceeds Expectations

2 – Does Not Meet Expectations5 – Significantly Exceeds Expectations

3 – Meets Expectations

(Complete rating and comments ONLY for Staff Performance Management)

# / Function/Standard / E/
M / DWMQAV / D
A
I
L
Y
% / Equipment Used / R
A
T
I
N
G / Comments
(Required for rating
of 1, 2, or 5)
1 / Supports the SERVICEplusphilosophy of Texas Tech / E / D / 100
STANDARD: Overall exhibits SERVICEplus orientation in work attitudes and actions, for example, appearance, attendance, cooperation, timely and courteous response, and attentiveness and has attended a SERVICEplusclass.
2 / Supports the Total Quality Management philosophy of the (Your Department Name) / E / D / 100
3 / Complies with Texas Tech’s policies, procedures, and work rules. / E / D / 100
# / Function/Standard / E
/
M / DWMQAV / D
A
I
L
Y
% / Equipment Used / R
A
T
I
NG / Comments
(Required for rating
of 1, 2, or 5)
  1. Indicate by number in the space provided which function(s) listed above necessitates the use of the following physical skills. NOTE: A function may have a number of physical skills required.

Strength: Sitting:

Stamina:Standing:

Physical Flexibility: Walking:

Reaction Time: Kneeling:

Whole body Steadiness: Crouching:

Manual Dexterity: Squatting:

Hearing:Crawling:

Visual Acuity: Twisting Upper Body:

Other: Climbing Hand Over head:

Employee Signature Date

**********SUPERVISOR’S COMMENTS**********

  1. Attach a detailed and updated organization chart showing this employee’s position within your organizational unit showing the current structure and new structure that will result from this action.
  1. List what you consider to be the qualifications for entry into the position.

Special licenses, registrations, or certificates?

TO BE COMPLETED BY PERSONNEL DEPARTMENT ONLY
Education or training?
Level and type of experience?
Can additional education/training be substituted for previous work experience?
Can additional work experience be substituted for required education/training?

COMPLETE REMAINDER OF FORM ONLY FOR STAFF

PERFORMANCE MANAGEMENT

(Additional space if necessary for comments)

# / COMMENTS (Required for rating of 1, 2, or 5)

CUSTOMER/PERSONAL RELATIONS:

1 – Unsatisfactory4 – Exceeds Expectations

2 – Does Not Meet Expectations5 – Significantly Exceeds Expectations

3 – Meets Expectations

Relationship with customers: Comments:

(Comments required on 1, 2, or 5 rating)

Relationship with fellow employees: Comments:

(Comments required on 1, 2, or 5 rating)

SUMMARY OF EVALUATION:

1 – Unsatisfactory4 – Exceeds Expectations

2 – Does Not Meet Expectations5 – Significantly Exceeds Expectations

3 – Meets Expectations

Overall Evaluation Rating:

Overall comparison to Previous Evaluation: (indicate one)

Above Minimal to No Change Below

Summary Comments: (Optional)

EVALUATOR SUGGESTIONS FOR EMPLOYEE DEVELOPMENT:

I concur with evaluator’s suggestions.

I do not concur with evaluator’s suggestions.

The following are my suggestions for development:

SIGNATURES:

This report is based on my observation and/or knowledge. It represents my best judgment of the employee’s performance.

Evaluator’s Signature:

Date:

Administrative Officer Signature:

Date:

Employee Signature:

Date:

Employee signature indicates only that this evaluation was reviewed by the employee and discussed with the evaluator. Disagreement with the evaluation or any items contained therein should be made in writing and presented to the evaluator. A copy of any written statement should also be presented to the Director of Personnel and will be placed with the evaluation instrument in the employee’s official personnel file. Questions or comments concerning this form or the execution of the operating policy should be made to the Director of Personnel at 2-3867.