Dd Form 2712 - Prisoner Evaluation
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1REPORT DATE
(YYYYMMDD)
PRISONER EVALUATION
1. NAME
2. REGISTRATION NUMBER
3. BRANCH
(Last, First, Middle)
4. HOUSING UNIT
5. DETAIL
6. CUSTODY LEVEL
7. PERIOD COVERED:
(YYYYMMDD)
FROM:
TO:
8. COMPLETED BY:
DORM/QUARTERS SUPV
WORK SUPV
OTHER
9. AREAS OF EVALUATION: (X the appropriate spaces)
The dormitory/quarters supervisor completes Section 1 only. The work supervisor completes Sections 1 and 2.
SECTION 1 - ATTITUDE AND TRAITS
POINTS
(X one box per row)
Unsatisfactory
Conforms
Exemplary
a. CONDUCT
(1)
(2)
(3)
(4)
(5)
Disciplinary Action
Minor Infractions
No Infractions
b. DISCIPLINE
(1)
(2)
(3)
(4)
(5)
Constant
Moderate
Minimal
c. SUPERVISION REQUIRED
(1)
(2)
(3)
(4)
(5)
d. ATTITUDE TOWARD
Poor
Borderline
Respectful
(1)
(2)
(3)
(4)
(5)
SUPERVISOR
Uncooperative
Moderate
Cooperative
e. COOPERATION
(1)
(2)
(3)
(4)
(5)
Unfavorable
Fair
Exceptional
f. PERSONALITY
(1)
(2)
(3)
(4)
(5)
Easily Led
Complies
Self-Reliant
g. GROUP CONFORMITY
(1)
(2)
(3)
(4)
(5)
Disruptive
Neutral
Positive
h. INFLUENCE ON OTHERS
(1)
(2)
(3)
(4)
(5)
Minimal
Average
Energetic
i. INITIATIVE
(1)
(2)
(3)
(4)
(5)
Volatile
Indifferent
Stable
j. TEMPERAMENT
(1)
(2)
(3)
(4)
(5)
k. TOTALS
=
OVERALL EVALUATION
l.
Unsatisfactory
Below Average
Average
Above Average
Outstanding
SUBTOTAL
10-16
17-27
28-38
39-49
50
SECTION 2 - WORK PERFORMANCE
POINTS
Poor
Acceptable
Outstanding
a. QUALITY OF WORK
(1)
(2)
(3)
(4)
(5)
Minimal
Average
Excellent Output
b. PRODUCTIVITY
(1)
(2)
(3)
(4)
(5)
Careless
Follows Rules
Safety Conscious
c. SAFETY
(1)
(2)
(3)
(4)
(5)
d. TOTALS
=
e. OVERALL EVALUATION
Unsatisfactory
Below Average
Average
Above Average
Outstanding
GRAND TOTAL
13-25
26-36
37-50
51-64
65
0
SECTION 3 - REMARKS
(Required if scores are substandard)
10.a. PRISONER SIGNATURE
b. DATE (YYYYMMDD)
11.a. EVALUATOR'S NAME
b. SIGNATURE
c. DATE (YYYYMMDD)
DD FORM 2712, MAR 2013
PREVIOUS EDITION IS OBSOLETE.
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