Completion Notes
This appraisal form is for Facilities staff.
Please note that all sections are compulsory and MUST be completed. Once completed a copy needs to be stored on the personal file and a copy given to the individual. To complete the appraisal please notify the team by email to giving the name of the appraisee, the date and the name of the appraiser.
When completing an appraisal, you can find additional assistance on the Trust intranet under A. It is recommended that you view these pages when preparing for your annual appraisal. If you require any additional information about the appraisal process or training courses, please email
There are six sections to your appraisal form. Please complete sections1 and 2 prior to your appraisal and return them to your appraiser one week before your appraisal date.New starters and new to role need to complete section 1prior to the meeting. Sections 3,4, 5 and 6 will be completed in the appraisal meeting.
Section 1–Personal details and code of conduct declaration
Section 2– Review of last year against Trust Values
Section 3–Review of last year’s objectives/training and development activities
Section 4 – New objectives and associated development/training activities
Section 5–Review of mandatory training and training required by job role
Section 6– Summary

Section 1 – Personal Details and declarations

Name / Line Manager
Directorate / AppraiseeBand
Appraisal
Date / Appraiser Name / Appraiser Job Title
The Code of Conduct for the Trust requires all employees to declare any conflicts of interests and any hospitality as outlined within the policy. It is the responsibility of every manager to identify any breaches of the Code of Conduct which should be managed and reported in accordance with the relevant HR policies
Do you need to declare any conflict of interests relating to your employment at HEFT? / YES / NO
As a guide, consider the following: -
(a) Am I, or might I be, in a position where I (or my family/friends) could gain from the connection between my private interests and my employment?
(b) Do I have access to information which could influence purchasing decisions?
(c) Could my outside interests be in any way detrimental to the NHS or to patient’s interests?
(d) The acceptance of gifts and hospitality from patients and relatives should always be declared to your supervisor and recorded appropriately.
(e) Employees facing criminal charges to give notice of this to their line manager whether they feel it is relevant or not.
Manager Comments:
Do you have any professional licencing requirements for your role? If so is the necessary licence is still valid?

Section 2 – Review of Last Year – against Trust values

Review the following statements, indicate howyou have demonstrated the Trusts Values of Caring, Honest, Accountable and Supportive by using the following guidelines - Requires some improvement (RI) Usually (U) Always (A)
Caring – Treating everyone with compassion and respect / Comments
I behave in an open, respectful and inclusive manner towards patients, customers and colleagues.
I am aware and respectful of the opinions of others and adjust how I speak to others (taking into account social, cultural backgrounds, age, gender and ability),
Honest – Truthful and open with all / Comments
I actively raise concerns aroundrisk, near misses, unsafe care or wrong doing and encourage orders to do so.
I challenge inappropriate behaviour and give prompt and constructive feedback in order to improve performance.
Accountable – Taking personal responsibility for doing my best / Comments
I take responsibility for decisions I make and take on board feedback so that I can change and improve.
I always strive to maintain the highest possible standards.
Supportive – Working together to get things done. / Comments
I am able to make common sense decisions that positively impact my department/duties.
I support my team and say thank you to others when they have gone out of their way to help me.

Section 3 –Review of Last Year’s Objectives/Training and Development activities

Activity/Objective / Target Completion Date / How did you achieve this? / Evidence provided
i.e. certificate? / Actual Completion date

Section 4 –New Objectives and Development/Training Activities (achievable within 12 months)

Objective / Target Date / Training/Development Activity Required
To represent the Trust positively / By being smart and professional at all times, adhere to the uniform policy
Will be smart and profession
Ensure that you and others are safe and well in work / Attend all of your Training Courses
Ensure that your working practices are sound / Adhere to all policies and procedures for your work area

Section 5 – Review of current mandatory trainingrequired for job role

Training Element / Frequency / Completed
YES/NO / Comments
Equality & Diversity / 3 yearly
Fire Safety / Annually
Information Governance / Annually
Major Incidence Awareness / 3 yearly
Health & Safety / 3 yearly
Food Safety / Annually
Waste Management / 3 yearly
Safeguarding / Annually
Healthwrap Prevent / Once only
Manual Handling – Load Handling / 2 yearly
Conflict Resolution / 3 yearly
Infection Control (Level 1) / 2 yearly
Basic Life Support / Once only
Local Induction / Once only(per new area)
Corporate Induction / Once only
Medical Gas Training – Porters/Estates / Annually
Patient Handling – Porters / 2 yearly
Blood Collection – Porters / 3 yearly
I have been notified that I have to undertake any future mandatory training on the date/time agreed with my Manager/Supervisor. I understand that non-attendance without prior agreement from my manager could result in performance management procedures.
Signed ……………………………………………………………………………………………

Section 6 – Summary

Overall Role Performance Comment - Individual / Overall Role Performance Comment - Manager
Individual Sign / Individual Date / Manager Sign / Manager Date

By signing above, you agree to the contents of this appraisal document and agree to action any objectives outlined. You also agree that if mandatory training is not completed, movement to the next pay increment could be deferred.

To complete the appraisal process, please email to giving the name of the appraisee, the date and the name of the person who carried out the appraisal.

1 / FACILITIES ONLY