Performance Assessment

Employee Name Title Date

Please check the appropriate box as indicated.
SA=Strongly Agree A=Agree IP=Improvement Possible D=Disagree SD=Strongly
Disagree
Communication S
A
A I
P
D S
D
Speaks clearly and concisely.
Is an efective listener.
Communicates efectively in writing.
Employee Sel!Evaluation"
Supervisor Comments#Action Plan"
Interpersonal Relations S
A
A I
P
D S
D
$nderstands t%e importance o on!t%e!&ob relations%ips' acilitates
relations%ips t%at add to %is#%er individual &ob success and to t%e success
o ot%ers.
E(%ibits tact) sensitivity) and discretion.
Is proactive and responsive wit% colleagues and co!workers.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"
Teamwork S
A
A I
P
D S
D
Can be counted on to %elp ot%ers inside and outside t%e department to
accomplis% institutional goals.
S%ares inormation and collaborates wit% ot%er team members w%ic%
enables t%e entire group to be efective' volunteers assistance.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"
Customer Service S
A
A I
P
D S
D
Is attentive and responsive to customers* needs and re+uests.
Is consistently courteous and respectul to customers.
Employee Sel!Appraisal"
Page 1 of 4
Supervisor Comments#Action Plan"
Job nowle!"e S
A
A I
P
D S
D
Demonstrates understanding o daily &ob re+uirements) e+uipment
operation) systems navigation.
,eeps up to date wit% tec%nical advances in t%e -eld.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"
#uality of task performance S
A
A I
P
D S
D
Accuracy) clarity) consistency and t%oroug%ness o work.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"
Pro!uctivity S
A
A I
P
D S
D
Completes amount o work re+uired and paces sel to meet demands o
assignments.
.ork assignments are efectively planned and organi/ed to meet
deadlines.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"
Initiative S
A
A I
P
D S
D
Is sel!motivated and re+uires little prompting rom supervisor.
Anticipates needed action' suggests better ways o doing t%ings.
Identi-es) prevents and#or recommends solutions to problems.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"
Reliability S
A
A I
P
D S
D
Is dependable and ollows t%roug% on commitments in a timely manner)
Page 2 of 4
meeting daily) weekly) and mont%ly deadlines.
Can be relied upon to see tasks t%roug% to completion and to ensure t%at
tasks are perormed compre%ensively.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"
Departmental$Institutional nowle!"e S
A
A I
P
D S
D
$nderstands and acts on pertinent departmental and program policies and
procedures.
$nderstands and acts on pertinent district policies and procedures.
Employee Sel!Appraisal"
Supervisor Comments#Action Plan"

%verall Ratin"
&eets e'pectations
Does not meet e'pectations( performance improvement plan to be complete!)
%verall Comments*
Development$Trainin" Plan
Describe t%e additional training or development activities an employee s%ould take to keep skill
levels current) prepare or t%e uture) meet c%anging &ob re+uirements) or overcome identi-ed
weaknesses or skill de-cits t%at %ave %ad an impact on perormance.
Personal Career +oal
Describe t%e development work an employee will undertake based on personal career ob&ectives.
0%is may include preparing or a career c%ange or striving toward a new c%allenge or promotion.
Employee" I understand t%at my signature does not necessarily indicate agreement and t%at I
%ave t%e rig%t to attac% to t%is evaluation my comments t%at I will submit wit%in -ve 123 working
days.
Employee" 44444444444444444444444444444444444444444444 Date" 44444444444
Supervisor" 44444444444444444444444444444444444444444444 Date" 44444444444
Director#Dean 1i applicable3" 44444444444444444444444444 Date" 44444444444
5ice President" 44444444444444444444444444444444444444444 Date" 44444444444
Page 3 of 4
Page 4 of 4