Confidential
Supervisors Comments:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Employee Comments:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Employee Goals for the next Evaluation (use separate sheet if necessary)
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
_______________________________ ___________
Employee’s Signature
Date
_______________________________
___________
Supervisor’s Signature
Date
_______________________________
___________
Manager’s Signature
Date
For Human Resources Use Only
Evaluation received on: ______________________
Follow-up action form received: ________________
Action approved by: _________________________