Performance Evaluation Form Non-Exempt Staff
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1
2
3PERFORMANCE EVALUATION FORM
NON-EXEMPT STAFF
Date:
Employee Name/Title:
Location:
Date of Hire:
Date Hired Into Current Position:
Division/Department:
Supervisor/Title:
Review Period:
Annual (Period:
to
)
Other (Reason:
)
INSTRUCTIONS: This form will be completed by the employee’s immediate supervisor and reviewed by the next level supervisor. When completed
and signed, a copy is given to the employee, a copy is retained by the supervisor, and the original is sent to Human Resources. Supervisors should
check the most appropriate rating, make an explanatory comment to support your rating, and cite specific examples of performance leading to
Unsatisfactory, Needs Improvement, or Exceeds Expectations ratings. For Unsatisfactory performance, list specific goals for improvement and the date
you expect them to be achieved. In addition, review the current job description with employee and contact Human Resources if you believe any
changes are appropriate.
Supervisor’s Initials
Employee’s Initials
I. JOB DESCRIPTION REVIEWED
Date:
II. PERFORMANCE EVALUATION
Needs
Meets
Exceeds
PERFORMANCE FACTOR
Unsatisfactory
Comments
Improvement
Expectations
Expectations
Job Competencies:
Understands
and
demonstrates
competence in job requirements set
forth in the job description.
Productivity:
Produces
an
acceptable
amount
of
work,
organizes
and
prioritizes
work,
utilizes
time
well
and
meets
deadlines.
Quality:
Completes
work
accurately
and
neatly
to meet
quality standards.
Responsibility/Initiative:
Accepts, begins, follows through,
and fulfills work assignments and
training.
Relationships:
Establishes and
maintains
effective
relationships
with others with whom interaction is
required.
Adaptability/Resourcefulness:
Adjusts to change with a minimum
of
disruption
to
productivity.
Contributes
useful
ideas
for
improved performance.
Conduct:
Conforms to policies
and
procedures;
demonstrates
appropriate workplace behavior.
Training:
Completes
required
training In a timely manner.
Attendance/Punctuality:
Conforms to standards for
attendance and punctuality.
Unplanned Absences in this review period:
days;
occurrences;
percentage of scheduled hours/shifts.
Lateness in this review period:
occurrences.
OVERALL EVALUATION
Unsatisfactory
Needs Improvement
Meets Expectations
Exceeds Expectations
Supervisor’s Signature_________________________ ___ Next Level Supervisor’s Signature _________________________________
Employee’s Signature____________________________________________
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