Sample Chief Executive Officer Performance Appraisal Process And Assessment Form Page 6

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Assessment of Essential CEO Accountabilities (cont.)
Circle the Applicable Performance Rating and
Include Your Comments
Community Health and Partnerships
1
2
3
4
5
N/A
•
Comments:
Instills community health and well-being as a fundamental
organizational belief
•
Collaborates with community leaders to assess the health
needs of the community and design programs and services to
maximize resources to address those needs
•
Seeks community partnerships to maximize resources and
impact on the greatest community health needs
•
Ensures resources and programs are made available to
address community health improvement challenges and
needs
CEO Self-Rating: [Insert CEO rating from self-evaluation here before giving to Board members]
CEO Comments: [Insert CEO comments from self-evaluation here before giving to Board members]
AHA 2017 Sample CEO Performance Appraisal Process and Assessment Form
6

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