Sample Chief Executive Officer Performance Appraisal Process And Assessment Form Page 2


comments should be incorporated into the Board’s version of the evaluation prior to the
distribution of the evaluation to the board. Placeholders for the CEO’s ratings and comments
are included in this evaluation form template.
3. Board Evaluation. The CEO evaluation should be distributed to all Board members, with clear
instructions about how to consider the criteria in forming a rating of performance, the
importance of providing comments where necessary, and the submission deadline. The
appraisal provided to Board members should include the CEO’s self-ratings and comments.
4. Summary Report. The evaluations should be collected, and responses compiled in a manner
that reveals an overall Board performance rating in each area, the CEO’s self-rating, and a
summary of comments made by both Board members and the CEO.
5. Board or Committee Review. Board members (or designated Committee members) should
meet to decide what to emphasize in their feedback to the CEO and discuss the final CEO
appraisal report. The Board (or designated Committee) should also review the CEO’s proposed
goals for the coming year, make any modifications necessary, and collaborate with the CEO to
ensure mutual agreement and commitment.
6. Final Documentation. The Board Chair should incorporate modifications to the evaluation
requested by the Board (or designated Committee) and ensure preparation of final
documentation of the CEO appraisal.
7. Personal CEO Feedback. The Board Chair (and identified other members of the Board) should
meet personally with the CEO to discuss the evaluation results. This session should provide
performance improvement feedback to the CEO, and stimulate a productive, two-way dialogue
with the CEO that includes his or her responses to the evaluation, and personal commitments
to leadership improvement. If a salary increase and/or bonus are communicated in the same
meeting, care should be taken to spend appropriate time providing feedback and not let
compensation become the principal focus of the conversation.
AHA 2017 Sample CEO Performance Appraisal Process and Assessment Form


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