Employee Performance Review Goodwill Industries of LSC

Performance Review – Intake and Referral QA

Employee Information

Employee Name: / Employee ID:
Job Title: / Hire Date:
Department: / Date in Position:
Manager: / Date Review Given:
Salary Adjustment: / Yes / No / Prior Review Date:

Purpose

Our goal is to assist the employee in the performance of his/her duties by presenting a constructive appraisal of his/her strengths and areas needing improvement. Also, it is our desire to develop these strengths by providing as much training as possible in order to achieve greater job satisfaction and performance.

Goals

Based on the previous performance review, briefly describe the goals identified for the employee. Were the goals achieved? If no, then why not?
Goal #1:
Goal #2:
Goal #3:
Goal #4:

Definitions

EXCELLENT: Performance consistently exceeds all job requirements; exceptional knowledge of the work; has expanded all job duties significantly beyond normal job expectations.
ABOVE STANDARD: Performance often exceeds some of the job requirements; takes initiative and identifies and suggests improved methods and procedures; anticipates and identifies potential problems.
STANDARD: Performance is fully acceptable; each of the job requirements is met in a competent manner; knowledgeable; needs little direct supervision.
BELOW STANDARD: Performance is inconsistent; additional skills are needed; needs more direct supervision.
UNACCEPTABLE: Performance does not meet many of the basic requirements necessary to perform the job adequately; performance is clearly below job demands; needs constant and direct supervision; improvement is required.
The following areas are important to the success of an individual performing the duties of an Intake Referral QA. Properly performing the duties of this position are critical to the mission of Goodwill Industries of Lower South Carolina. As the individual with oversight for issues regarding employees well being, less than standard performance cannot be tolerated. It is important to note, that some areas of this position are much more vital to the success of our Agency and are given a higher weight in the overall evaluation process.

Evaluation

Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
1.  Quality of Work / / 25 / 20 / 15 / 5 / 0
As central point of contact for PWC, effectively manages phone and email queue of Veterans and Veteran’s family members interested in the services provided by PWC to include answering incoming calls and emails.
Comments:
Points:______
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
2.  Professional Competence and Job Knowledge / 25 / 20 / 15 / 5 / 0
Conducts all initial intakes and assessment with Veterans; to include obtaining documentation and demographic information. Identifies appropriate internal staff referrals.
Comments:
Points:______
Evaluation
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
3.  Consistency / 25 / 20 / 15 / 5 / 0
Monitors and follows-up on internal referrals and course of action; provide updated information to LCSW regarding referral process and actions taken
Comments:
Points:______
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
4.  Interpersonal Skills / 25 / 20 / 15 / 5 / 0
Maintains current knowledge of, and working relationships with, community resources and social service providers.
Comments:
Points:______
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
5.  Accuracy and Compliance / 20 / 15 / 10 / 5 / 0
Assures that the intake process is complete and that all information has been accurately entered into database. Creates appropriate referrals within agency based on Veteran’s identified needs.
Comments:
Points:______
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
6.  Teamwork / 20 / 15 / 10 / 5 / 0
Meets changing conditions of the position and willing to go beyond the scope of the job description to meet departmental needs. Serves as back up for PWC staff as needed. Professional, polite, helpful and shows flexibility when working with fellow employees, supervisors, and managers. Respects and is respected by fellow employees as a team player.
Comments:
Points:______
Evaluation
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
7.  Communication Skills / 20 / 15 / 10 / 5 / 0
Communicates effectively, orally and in writing as applicable.
Comments:
Points:______
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
8.  Creativity / 15 / 10 / 5 / 2 / 0
Coordinates with other internal staff and programs so that opportunities for Veterans can be maximized.
Comments:
Points:______
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
9.  Attendance / 15 / 10 / 5 / 2 / 0
Conforms to scheduled work hours and breaks to include following procedures for reporting absences and tardiness.
Comments:
Points:______
Factor to be Rated / Excellent / Above Standard / Standard / Below Standard / Unacceptable
10.  Personal Appearance / 15 / 10 / 5 / 2 / 0
Dresses in a neat and professional manner consistent with the company’s personal appearance and/or uniform policy as stated in the employee handbook.
Comments:
Points:______
Overall Performance Rating
This rating is determined by finding the Total of the numerical ratings given in Parts 1 through 10.
TOTAL NUMERICAL RATING:
Unacceptable 0 - 40
Below Standard 41 - 82
Meets Standards 83 - 124
Above Standards 125 - 167
Excellent 168 - 205
Employee’s Strengths: Indicate strengths by using specific examples of work performance.
Areas of Improvement: Indicate areas needing improvement with specific examples of problems that have occurred.
Supervisor Comments:
Employee Comments:
Employee Training Needs Self-Assessment (To be completed by the employee)
PURPOSE: It is our desire to develop your strengths to achieve greater job satisfaction and performance. In order to help you do this, we need to know what training opportunities you think would assist you achieving them.
I think the training opportunities listed below would help me in developing my strengths:
Goals, Objectives and Training Programs
Identify specific developmental activities and future training opportunities that will capitalize on strengths and/or strengthen areas needing improvement. Indicate a target date for completion of future training and development activities.
Goal #1 / Completion Date:
Goal #2 / Completion Date:
Goal #3 / Completion Date:
Goal #4 / Completion Date:

Verification of Review

By signing this form, you confirm that you have discussed this review in detail with your supervisor. Signing this form does not necessarily indicate that you agree with this evaluation.
I, acknowledge receipt of review, and my signature does not necessarily indicate agreement.
Employee Signature / Date
Manager Signature / Date

Developed by: C Scarborough Confidential and Proprietary to Goodwill Industries of LSC Rev: 03/26/15/00

INTAKE AND REFERRAL QA Page 4 of 6