Performance Evaluation Page 1
Date of Last Evaluation:
Date of Hire:
# of years in current position:
This form is designed to facilitate the performance evaluation of _____________ Department employees. In preparing for performance evaluation, the
supervisor should review the employee's position description, the employee's previous performance evaluation form, the employee's actual performance on
the job for the rating period, performance logs (if applicable) and then evaluate the employee's performance by completing this form. The employee is
encouraged to prepare a self-appraisal form to discuss with the supervisor at the performance evaluation interview. The performance evaluation interview is
a one-on-one conversation held between the supervisor and employee in order to openly discuss the employee's performance. The supervisor and
employee should also work together to set goals for the upcoming performance evaluation period including a discussion of training/development areas, job
objectives and special projects. A final performance evaluation is prepared and signed by the employee, the supervisor, the second-level supervisor (if
applicable) and the department head. The original performance evaluation form is filed in the employee's personnel file.
ACCOMPLISHMENT OF MAJOR WORK OBJECTIVES
In this section, record in priority order, major work objectives set in last year's performance evaluation session. If there were additional objectives and/or any
changes to agreed upon objectives throughout the year, be sure to record all such additions and the most recent revisions. Record specific results achieved
against those objectives. If this section does not apply, write "N/A.”
In this section, assess each performance factor and circle the numerical value that best describes the employee's level of performance. If a particular
performance factor does not apply, write "N/A.” The supervisor is encouraged to use the "Comments" section for significant comments descriptive of the
employee's performance. This includes specific examples related to the employee's performance including guidance for further development. Ratings of a
"1" or a "5" MUST be justified in the "Comments" section. Descriptions of performance ratings are included with each performance factor. The supervisor
and employee should also keep the following general guidelines in mind when assessing performance. These guidelines are especially useful when
determining the rating for the employee in the 1 to 2 range or the 4 to 5 range.
Consistently outstanding performance, which exceeds stated objectives and/or goals.
Consistently seeks greater responsibilities; makes
suggestions; takes initiative to improve process/program; carries out duties in an exceptional manner; independent; demonstrates exceptional skills
level. Employee contributes to the performance of the division or department in a significant manner.
Consistently superior performance, which sometimes exceeds stated objectives and/or goals. Assumes more responsibility and performs above
standards with minimal supervision.
Consistently strong performance. Responsibilities are met in a wholly satisfactory manner. Normal guidance and supervision are required.
Consistently marginal performance. Employee sometimes performs at acceptable levels but lacks consistency. Rarely exceeds and often falls
short of desired results. Direction, supervision and training are required if objectives, duties and performance factors are to be met.
Consistently unacceptable performance. Inconsistent and ineffective performance. Work is not contributing to the division's goals; individual goals
and duties are not being achieved on a regular basis; performance results are not acceptable.