Social Security Number:
Date of Review:
Date of Last Review:
Department
Period of Review
From:
To:

Ratings Key: Consider the degree work meets acceptable standards.

1. Consistently Below Expectations

2. Below Expectations

3. Meets Expectations

4. Exceeds Expectations

5. Consistenly Exceeds Expectations

6. Unobservable or Not Applicable

WORK QUALITY

How accurate, neat and complete is the individual's work? Give an example or reason.

PRODUCTIVITY

Does the individual effectively use available working tiime; plan and prioritize work; set and accomplish goals and complete assigments on schedule? Give an example or reason

KNOWLEDGE OF JOB

Is individual familiar with the requirements of the position and the methods, practice, and equipment to complete the job? Give an example or reason.

ADAPTABILITY

How well does the individual adjust to changes in job assignments, methods, personnel and surrounding? Give an example or reason

DEPENDABILITY

Is the individual consistent in perfoming work assignments and carrying out instructions? Consider the amount of supervision required and willingnbess to take on responsabilities and to be accountable for them. Give an example or reason.

INITIATIVE AND RESOURCEFULNESS

Does the individual notice projects to be done and then takes the appropiate action? Has the individual developed and/or carried out new ideas or methods, offered suggestions, anticipated needs and sought additional tie to complete tasks? Give an example or reason.

JUDGMENT

Does the individual excersice ability to decide correctly or choose best course of action when some decision must be made? Does the individual work in a safe manner, preventing accidents injuries and theft? Give an example or reason.

RELATIONSHIPS WITH PEOPLE

Does the individual work effectively with others (supervisors, peers, subordinates)? Consider respect and courtesy show to others, how attitude affects the work area, willingess to accept supervision, and attitude exhibited toward company as well as own job. Are apparel, manners and sociability appropiated to the job responsbilities? Give an example or reason.

ATTENDANCE

Is the individual punctual when reporting to work? Does the individual adhere to the time limits for breaks and lunches? Does the individual follow company policy on sick leave, approval for vacation, and give prompt notice of absence due to illness? Give an example or reason.

COMMUNICATION SKILLS

To what extent does the individual demostrate the ability to comunicate effectively in both oral and written expression with other employees and his/her supervisor? Are issues dealt with and resolved constructively? Give an example or reason.

LEADERSHIP ABILITY

Is the individual able to motivate co-workers to accept and complete assignments in a timely and satisfactory matter?

GOALS FOR NEXT YEAR:

What goals will the employee achieve to improve his/her performance on the job?

TO BE COMPLETED BY
1
2
3
4
5

EMPLOYEE COMMENTS

If the employee wishes to do so, any comments concerning the Performance improvement Plan or the evaluation (for example, agreement or disagreement) may be indicated in the space provided below

REVIEWER'S COMMENTS

I have reviewd this document and discussed the contents with my supervisor. My signature means that I have been advised of my performance status and does not necessarily imply that I agree this evaluation.