Employee name: _______________________ Position: ______________________
Supervisor name: ______________________ Department: ___________________
Review period: ________________________ Date: _________________________
To be completed by the employee's immediate supervisor. Copies will be provided to the employee being reviewed and the employee's supervisor. The original will be retained by the human resources department.
SECTION 1 - PERFORMANCE REVIEW
Employees are evaluated on each of the factors listed below. Please use space on the back for comments if the rating circled is D or U and specify which factor you are commenting on.
Outstanding—Results significantly surpass expectations. Superior contribution to the objectives of the employee's performance in assigned areas of responsibility.
Proficient—Results are very good. Significant contribution to objectives of the department and functional area.
Competent—Results are good. Performance is consistent with expectations. No important areas of failure or lack of accomplishment.
Developing—Results do not consistently meet expectations. May lack experience but has the capacity to improve the overall level of performance within a reasonable period of time.
Unacceptable—Performance does not meet expectations. Significant failure to meet job expectations. Performance improvement plan to be established.
Factor | Description | Circle One |
Customer Service | Provides prompt, high-quality service to members, staff, vendors and internal/external customers. | O P C D U |
Communication | Creates effective working relationships by information sharing. | O P C D U |
Teamwork | Consensus building and using active listening skills. | O P C D U |
Achievement | Ability and willingness to achieve organizational and individual goals by seizing opportunities and learning from experience. | O P C D U |
Flexibility/Innovation | Initiates new ideas, exhibits creative thinking and grasps new concepts. | O P C D U |
Technical Excellence | Develops and applies technical and role specific skills and organizational knowledge. | O P C D U |
SECTION 2 - OVERALL PERFORMANCE RATING
Varying degrees of importance should be placed on those factors measuring performance in a given job. The overall performance rating represents a composite of the reviewer's opinion, judgment and impressions of the employee's performance.
Circle One: O P C D U
SECTION 3 - KEY DEVELOPMENT AREAS
Identify two or three key developmental areas the employee should focus on over the next year. Develop a plan to provide formal or informal training in these areas.
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SECTION 4 – EMPLOYEE COMMENTS
___________________________________________________________________
___________________________________________________________________
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SECTION 5 - APPROVALS/CONCURRENCES
Employee signature: _______________________________________Date _______________
(This report has been discussed with me. I understand that my signature does not necessarily indicate agreement; I can make my disagreement, if any, known by a written communication to my immediate supervisor, with a copy to the Human Resource Department.)
Reviewer ______________________________________________ Date ______________
Department head _______________________________________ Date ______________
Human resources _______________________________________ Date ______________
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