Performance Appraisal: Employee Review Form

Name _______________________________              Job Title____________________

Manager ____________________________               Department __________________

Review Period   From _______________ To _______________

Purpose of Review:
____ Introductory       ___ Annual Performance       ___ Other: ____________________

Score the performance in each job factor below on a scale of 5 - 1, as follows:

5 = Outstanding, consistently exceeds this job factor expectation and is recognized by peers and/or customers as a leader and positive example for others.

4 = Above Expectations, consistently meets and occasionally exceeds this job factor expectation.

3 = Meets Expectations, consistently meets this job factor expectation.

2 = Below Expectations, occasionally fails to meet this job factor expectation.

1 = Needs Improvement, consistently fails to meet this job factor expectation and a job performance improvement plan is required.

Section 1 - Job Performance (60% of total score)

Enter up to five job knowledge and skill factors from the job description SCORE

______________________________________________               _____

______________________________________________               _____
                
______________________________________________               _____

______________________________________________               _____

______________________________________________               _____

Quality of work__________________________________               _____

Quantity of work_________________________________               _____

Negotiable item__________________________________              _____

Overall Score (Add all scores and divide by the number of factors) x 12 =_____

Comments:

________________________________________________________________________________________________________________________________________________________________________________________________

Section 2 – Personal Performance (20% of total score)

Dependability __________________________________               _____

Attendance & punctuality__________________________              _____

Interpersonal skills_______________________________              _____

Flexibility __________________________________                      _____

Communication skills ______________________                           _____

Teamwork ____________________________                                _____

Customer service ______________________                                _____

Negotiable item ____________________________                       _____

Overall Score (Add all scores and divide by the number of factors) x 4= _____

Comments
________________________________________________________________________________________________________________________________________________________________________________________________

Section 3 - Personal Improvement (20% of total score)

Change environment support_______________________             _____

Quality Improvement support_______________________             _____

Professional growth______________________________              _____
  
Developmental goal accomplishment________________               _____

Negotiable item ______________________                                    _____

Overall Score (Add all scores and divide by the number of factors) x 4= _____

Comments
______________________________________________________________________________________________________________________________________________________________________________________________


Add Overall Scores from Section 1-3 =Total Score _____


Developmental goals for next review period

1. ___________________________________________________________
2. ___________________________________________________________
3. ____________________________________________________________

Signatures

Employee _________________________________________ Date __________


Employee Comments:
_____________________________________________________________________________________________________________________________________________________________________________________________

Supervisor/Manager _________________________________ Date __________

Department Head ___________________________________ Date __________

Human Resources ___________________________________Date __________