Performance Appraisal Form Page 2
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1
2General Factors
Rating
Scale
Supportive Details/Comments
O ¨
7.
Creativity – The extent to which an
100-90
Points
____________________________________
V ¨
employee proposes ideas, finds new
89-80
G ¨
and better ways of doing things.
79-70
____________________________________
I ¨
69-60
U ¨
Below 60
____________________________________
O ¨
8.
Initiative- The extent to which an employee
100-90
Points
____________________________________
V ¨
seeks out new assignments and assumes
89-80
G ¨
additional duties when necessary.
79-70
____________________________________
¨
I
69-60
U ¨
Below 60
____________________________________
O ¨
9.
Adherence to Policy- The extent to which an
100-90
Points
____________________________________
V ¨
employee follows safety and conduct rules,
89-80
G ¨
other regulations and adheres to company
79-70
____________________________________
¨
policies.
I
69-60
U ¨
Below 60
____________________________________
O ¨
10. Interpersonal Relationships- The extent to which an
100-90
Points
____________________________________
V ¨
employee is willing and demonstrates the ability to cooperate,
89-80
G ¨
work and communicate with coworkers, supervisors,
79-70
____________________________________
¨
subordinates I and/or outside contacts.
I
69-60
U ¨
Below 60
____________________________________
O ¨
11. Judgement- The extent to which an employee
100-90
Points
____________________________________
V ¨
demonstrates proper judgment and decision-
89-80
G ¨
making skills when necessary.
79-70
____________________________________
I ¨
O
69-60
U ¨
V
Below 60
____________________________________
G
I
¨ ¨ ¨ ¨ Outstanding
Rate employee’s overall performance in comparison to position duties and responsibilities
U
100-90
¨ ¨ ¨ ¨ Very Good
89-80
¨ ¨ ¨ ¨ Good
79-70
÷ ÷ ÷ ÷ Number of Factors Rated
¨ ¨ ¨ ¨ Improvement Needed
Total Points
=
Overall Rating
69-60
¨ ¨ ¨ ¨ Unsatisfactory
Below 60
Complete all of the following sections
1.
_____________________________________________________
Accomplishments or new abilities demonstrated since last review
_____________________________________________________________________________________________________
2.
_________________________________________________________________________
Specific areas of needed improvement
_____________________________________________________________________________________________________
3.
Recommendations for professional development (seminars, training, schooling, etc.)____________________________________________
_____________________________________________________________________________________________________
4.
_______________________________________
__________________________
Absences: Number of incidents
Number of days
Employee’s Comments*_________________________________________________________________________________
_____________________________________________________________________________________________________
*
If necessary, additional sheets may be attached
Discussed with individual on ________________________Employee’s Signature_________________________________________________
*I acknowledge that this Performance Appraisal was discussed with me
Follow-up requested/desired
Yes
No
Follow-up Date____________________
Evaluator’s Signature____________________________________________________________________ Date________________________
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