Performance
Review
Form



Name:
 
 Date
of
Evaluation: 

Job
Title: 
 Department: 

Months
in
this
Position:
 
 Review
Period: 



PART
I
–
Introduction



Employee
Commitment:

Our
Company
recognizes
that
it’s
employees
are
a
crucial
ingredient
to
the
quality

and
success
of
it’s
products
and
services.

It
is
our
commitment
to
support
the

development
of
our
staff
both
professionally
and
personally
and
in
doing
so
create

an
organization
with
the
ability
to
exceed
the
expectations
of
the
company,
the

individual
and
our
clients.



Purposes
of
Performance
Reviews:

The
primary
purpose
of
a
performance
review
is
to
encourage
staff
development
and

strengthen
the
departments
overall
effectiveness
by:



1. identify
specific
indicators
of
achievement

2. pin‐point
areas
of
greatest/least
effectiveness

3. stimulate
improved
performance

4. aid
in
promotion,
retention
and
salary
decisions

5. clearly
define
the
goals
and
objectives
of
the
organization

6. develop
mutually
established
employee
focused
goals
and
objectives

7. increase
employer‐employee
communications

8. evaluate
effectiveness
of
management



Review
Expectations:

Each
employee
is
entitled
to
a
thoughtful
and
careful
review.

Performance
review

success
depends
on
both
the
supervisor’s
willingness
to
complete
a
constructive
and

objective
assessment,
and
on
the
employee’s
willingness
to
respond
to
constructive

suggestions
for
improvement
and
work
with
the
supervisor
to
identify,
overcome,

and
establish
goals
and
objectives
that
will
eliminate
performance
barriers.

Reviews

should
be
performed
within
90
to
180
days
of
the
employee’s
initial
employment
and

once
a
year
thereafter.



 

PART
II
–
Discussion
Questions

Part
II
will
be
completed
in
advance
by
the
employee
and
then
reviewed
and

discussed
during
the
formal
review
process.

Respond
to
each
question
with
a
rating

of
1,
2,
3
or
4
where
1
would
represent
a
low
rating.

Comments
are
encouraged,

especially
for
ratings
of
1
and
4.

Responses
are
not
required.



Note:
The
HR
department
will
send
this
section
to
the
employee
2
‐
3
weeks
prior
to

the
formal
review.

The
employee
must
return
the
section
well
in
advance
of
the

review
so
that
HR
can
incorporate
the
responses
into
the
rest
of
the
evaluation

document.



1. Expectations
and
Roles:

a. Do
you
know
what
is
expected
of
you
in
your
current
role?

 

b. Do
you
believe
others
know
what
you
are
expected
to
do?
 

c. Do
you
have
a
clear
understanding
of
your
group’s
core
objectives
for
this

year?

 



2. Facilitation:


a. Do
you
have
the
materials
and
equipment
you
need
to
do
your
work
to
the

level
you
and
your
team
are
expected?
 

b. Do
you
feel
you
receive
the
leadership
necessary
to
do
your
work
to
the

level
you
and
your
team
are
expected?
 

c. Are
you
given
the
time
necessary
to
do
your
work?
 



3. Right
Seat
on
the
Bus:


a. In
this
role
and
with
this
team,
do
you
have
an
opportunity
to
do
what
you

do
best
every
day?
[1
=
0‐30%,
2
=
31‐50%,

3=
51‐85%,
4=86‐100%]
(response)


i. What
is
it
you
do
best?
(response/no
number) 

ii. You
are
most
engaged
when?
(response/no
number) 



4. Recognition
and
Support:


a. Do
you
feel
that
team
members
are
adequately
recognized
for
their

achievements?
 

b. How
do
you
like
to
be
shown
you
are
valued
or
shown
recognition?

(response/no
number) 

c. Does
someone
at
work
care
about
you
as
a
person?
 


 

5. Encouragement
and
Development:

a. Do
your
peers
encourage
your
development?
 

b. Is
there
a
leadership
member
who
is
encouraging
you
in
your

development?
 

 

PART
III
–
Professional
Attribute
Rating

Part
III
will
be
completed
in
advance
by
the
supervisor
and
then
reviewed
and

discussed
during
the
formal
review
process.

For
each
evaluation
principal,
please

select
the
statement
by
placing
an
‘’
in
the
Text
Box
that
describes
the
employee

the
best.

Type
the
number
in
the
Text
Box
if
the
employee’s
rating
is
not
a
whole

number.



A
rating
of
‘4’
is
to
be
given
when
someone
demonstrates
leadership
with
regards
to

the
specific
principal.

They
are
a
catalyst,
with
a
commitment
to
maintaining
a

vigorous
pursuit
of
a
clear
and
compelling
vision,
stimulating
higher
performance

standards
with
regards
to
the
specific
principal.



A
rating
of
a
‘3’
is
to
be
given
when
someone
demonstrates
leadership
with
regards

to
the
specific
principal.

They
are
committed
to
maintaining
pursuit
of
a
pre‐
determined
standard
with
regards
to
the
specific
principal.



A
rating
of
a
‘2’
is
to
be
given
when
someone
supports
the
established
principals



A
rating
of
a
‘1’
is
to
be
given
when
the
employee
fails
to
meet
some
portion
of
the

principal.





Comments
are
required
for
a
rating
of
1
or
4,
otherwise
comments
are
encouraged.



Note:
the
HR
department
will
send
this
section
to
the
supervisor
one
month
prior
to

the
formal
review.

The
supervisor
must
return
the
section
in
advance
of
the
review

so
that
HR
can
incorporate
the
response
in
to
the
rest
of
the
document.



Evaluation
Principals:



1. Commitment
to
Quality/Quality
of
Work:

Consider
the
degree
to
which
the

employee
is
committed
to
following,
promoting,
protecting
and
improving
the

quality
principals
as
outlined
in
our
Quality
Manual.

Consider
the
degree
to
which

the
employee
produces
accurate,
neat,
timely
and
thorough
work.




Selection
 Description/Explanation
 Rating

Consistently
demonstrates
quality
ethics,
ensuring
that
 4


 procedures
are
accurately
documented
and
followed.

Always

looking
for
ways
to
improve
quality.

Produces
work
of
the

highest
quality,
requiring
minimal
or
no
re‐work.



 Clearly
demonstrates
a
strong
commitment
to
defining
new
 3


 and
following
existing
quality
principals.

Produces
high
quality

work;
makes
few
errors,
requiring
minimal
re‐work.



 Mostly
adheres
to
established
quality
principals
and
 2


 procedures.

Produces
acceptable
work
with
minimal
errors,

requiring
some
re‐work.





 Struggles
to
find
value
in
quality
principals.

Produces
marginal
 1


 to
unacceptable
work;
makes
excessive
errors,
requires

repetitive
rework.



Comments/Performance
Examples:
 



Current
rating
of
 
indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period



2. Dedication:

Consider
the
degree
to
which
the
employee
is
dedicated
to
their

success
within
the
organization.

Does
the
employee
arrive
at
work
each
day

prepared
to
be
his/her
best
and
do
they
give
their
best
and
to
perform
their
job
at

a
high
level
of
effort.



Selection
 Description/Explanation
 Rating


 Prepares
in
advance,
so
that
when
they
arrive
each
day
they
are
 4


 ready
to
take
on
the
challenges
of
the
day.

Throughout
the
day

continually
gives
their
best
effort.


 Arrives
at
work
prepared
to
perform
their
job
at
a
high
level
of
 3


 effort
and
is
flexible
in
responding
to
daily
challenges.

Typically

gives
their
best.


 Gives
little
thought
to
preparations
for
their
job.

Most
of
the
 2


 time
performs
at
the
acceptable
level
of
effort.


 Does
little
to
ensure
their
success.

Some
of
the
time
performs
 1

at
an
acceptable
level
of
effort.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period










3. Knowledge
of
Job:
Consider
the
employee’s
skills
to
accomplish
their
job;
e.g.,


job
knowledge
gained
through
experience,
continued
education
and
specialized

training.


Does
the
employee
maintain
current
knowledge
about
changes
in

policy
and
procedure;
keep
abreast
of
new
developments
and
major
issues
in

their
field.

Consider
the
employee’s
willingness
to
learn
and
change
to
make

themselves
and
the
company
stronger.



Selection
 Description/Explanation
 Rating


 Consistently
exhibits
exceptional
knowledge
and
outstanding
 4


 skills
in
even
the
most
complex
aspects
of
the
job.

Requires
no


 assistance
to
perform
their
duties
associated
to
their
job.


Shares
their
knowledge
with
other
employees.

Goes
above
and

beyond
to
keep
current
with
emerging
trends
within
their
job

responsibilities
and
the
industries
served
by
the
organization.




 Frequently
demonstrates
better
than
average
knowledge
and
 3


 skills
in
all
aspects
of
the
job.

Requires
infrequent
assistances.


Shares
their
knowledge
with
other
employees.

Makes
a

continual
effort
to
gain
additional
job
related
knowledge.


 Has
adequate
knowledge
and
skills
to
handle
job
duties.


 2


 Requires
some
assistance.

Is
comfortable
with
job
knowledge

and
makes
an
effort
when
asked
to
learn
additional
skills
or

seek
additional
knowledge.


 Application
of
knowledge
is
limited.

Required
skills
are
poorly
 1


 demonstrated.

Requires
considerable
assistance.

Makes
no

effort
to
improve
job
knowledge
or
remain
current
with
new

technologies
or
is
making
an
effort
to
no
avail.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period








4. Productivity/Time
Management:
Consider
how
the
employee
effectively
uses

available
working
time,
plans
and
prioritizes
work,
accomplishes
goals
and

completes
assignments
on
schedule.

Consider
how
well
the
employee

establishes
realistic
milestones
for
task
completion
and
how
well
they
multitask.


Does
the
employee
use
time
wisely
and
do
they
stay
on
task.




Selection
 Description/Explanation
 Rating


 Consistently
completes
all
work
on
schedule;
seeks
additional
 4


 tasks;
highest
output
level.

Uses
time
extremely
wisely
doing


 what
they
should
be
doing.

Time
lines
are
well
thought
out
and

milestones
are
met
or
exceeded.


Multitasking
is
common
and

done
well
and
with
little
to
no
effect
on
deadlines.



 Completes
the
majority
work
on
schedule;
above
average
 3


 output
level.

Uses
time
wisely,
typically
doing
what
they
should

be
doing.

Milestones
are
typically
met
without
adjusting
the

timeline.


Multitasking
done
well
and
with
minimal
effect
on

deadlines.


 Completes
most
work
within
specified
deadlines;
acceptable
 2


 output
level.


Uses
time
well
with
little
time
spent
with

personal
issues
or
doing
unrelated
tasks.

Milestones
are

typically
met,
yet
timelines
are
sometimes
adjusted.


Multitasking
is
done
with
effort
and
some
effect
on
deadlines.


 Does
not
complete
work
within
time
limits,
generally
 1


 unsatisfactory
output
level.


Typically
gets
distracted
with

personal
issues
or
doing
unrelated
tasks.

Milestones
are
not

typically
met.

Multitasking
is
difficult,
poorly
done
and

adversely
impacts
deadlines.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period








5. Initiative:

Consider
the
degree
to
which
the
employee
demonstrates

independent
action
and
resourcefulness
on
the
job
by
developing
new
methods,

offering
constructive
suggestions,
and/or
seeking
additional
work.


Are
they

frequently
looking
for
solutions
and
are
they
willing
to
help
make
them
happen.



Selection
 Description/Explanation
 Rating


 Consistently
exceeds
requirements
for
independent
action
and
 4

resourcefulness;
highly
motivated.



 Exceeds
requirements
for
independent
action
and
 3

resourcefulness;
diligent
worker.


 Meets
basic
job
requirements
for
independent
action
and
 2

resourcefulness;
acceptable
worker.



 Rarely
initiates
independent
action
as
required
by
the
job;
 1

requires
constant
supervision.


Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period










6. Work
Ethics
and
Innovation:
Consider
the
degree
to
which
the
employee


properly
handles
confidential
information,
their
adherence
to
policies,
and
their

commitment
to
productivity,
coworkers,
work
schedules
and
their
ability
to
add

value
to
department.

Are
apparel,
manners
and
sociability
appropriate
to
the
job

responsibilities?

Consider
the
degree
to
which
the
employee
maintains
their
work

environment.






Selection
 Description/Explanation
 Rating


 Practices
exceptional
work
ethics;
demonstrates
exceptional
 4


 integrity
in
all
work,
exceptional
contribution
to
efficient


 operation
of
unit,
consistently
seeks
ways
to
improve
work

methods.


Maintains
a
healthy,
well
organized
work

environment.

Always
looking
at
ways
to
improve
the
work

culture.


 Practices
excellent
work
ethics;
demonstrates
excellent
 3


 integrity
in
all
work,
develops
methods
for
streamlining


 operations,
frequently
provides
constructive
suggestions.



Maintains
a
healthy,
organized
work
environment.

Is
willing
to

support
suggested
improvements
in
culture.



 Practices
good
work
ethics;
demonstrates
integrity
in
all
work,
 2


 develops
better
methods
of
completing
work,
occasionally

provides
constructive
suggestions.


Could
be
better
organized.


 Fails
to
practice
good
work
ethics;
does
not
demonstrate
 1


 integrity
at
work,
doesn’t
provide
constructive
suggestions.


Is

disorganized
and/or
working
in
an
unhealthy
environment.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period










7. Decision
Making/Problem
Solving:
Consider
the
degree
to
which
the
employee

recognizes
and
analyzes
problems,
evaluates
solutions,
and
makes

recommendations.


Consider
their
ability
to
share
opinions
and
disagreements
in

a
healthy
way.

Consider
the
degree
to
which
the
employee
deals
with
stress
and

frustration
in
a
productive
and
non‐distracting
way.





Selection
 Description/Explanation
 Rating


 Consistently
demonstrates
outstanding
problem‐solving
skills;
 4


 able
to
handle
complex
problems
creatively.

Listens
to
others

opinions
and
presents
arguments
clearly
and
concisely
when
in

disagreement.

Acknowledges
stress,
uses
it
to
help
motivate

them,
while
preventing
it
from
causing
distraction.


 Demonstrates
good
problem‐solving
skills;
occasionally
able
to
 3


 handle
complex
problems.

Participates
professionally
in
a

disagreement.

Sometimes
requires
help
in
coping
with

stressful
situations.

Typically
is
able
to
keep
stress
related

distractions
to
a
minimum.



 Solves
routine
problems
satisfactorily;
requires
assistance
with
 2


 complex
problems.

Requires
some
assistance
in
presenting

arguments
in
a
disagreement.

Prefers
to
avoid
stressful

situations.


 Has
difficulty
recognizing
and
solving
routine
problems;
does
 1


 not
show
evidence
of
needed
analytical
skills.


Does
not
deal

well
with
stress
or
frustration,
which
often
causes
them
to
be

distracted.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period










8. Quality
of
Interpersonal
Relationships:
Consider
the
degree
to
which
the

employee
interacts
and
works
harmoniously
with
clients
and
co‐workers
within
or

outside
the
department
or
organization.

Consider
their
ability
to
work
with

others
including
diplomacy,
cooperation,
leadership,
etc.


Consider
their
ability
to

influence,
support
and
motivate
staff
and/or
coworkers.

Do
they
demonstrate

concern
for
their
co‐workers
and
the
company,
our
resources
and
reputations?

Does
the
employee
speak
and
hear
the
truth?



Selection
 Description/Explanation
 Rating


 Consistently
achieves
outstanding
working
relationships,
 4


 inspires
staff
and/or
coworkers
to
excel,
and
leads
by
example.



Exceptional
in
anticipating
and
meeting
others
needs;

communicates
very
well
with
everyone.


 Helps
to
create
a
cooperative
work
environment;
good
team
 3


 worker,
promotes
initiatives,
makes
effective
decisions.


Anticipates
and
meets
the
needs
and
communicates
well
with

others.


 Typically
is
cooperative;
works
well
with
others,
makes
good
 2


 decisions,
supports
progress
of
staff
and/or
coworkers.



Sometimes
fails
to
respond
promptly
or
clearly
in

communications
to
others.


 Sometimes
uncooperative;
experiences
difficulty
relating
to
 1


 others,
occasionally
disregards
staff
and/or
coworkers.

Fails
to

respond
or
meet
the
needs
of
others.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period




9. Diversity:
Consider
how
well
the
employee
supports
diversity
initiatives.

Contributes
to
building
an
enlightened
community
by
creating
a
climate
of

openness
and
inclusiveness.

Actively
seeks
out
mutually
held
values
with
other

employees
while
respecting
and
valuing
individual
differences.

Does
the

employee
show
respect
for
all
persons,
their
differences
and
freedom
to
express

themselves?



Selection
 Description/Explanation
 Rating


 Works
diligently
to
foster
an
open
and
inclusive
environment;
 4


 actively
involved
in
diversity
initiatives;
always
displays
behavior

that
respects
and
values
individual
differences.



 Provides
support
for
an
open
and
inclusive
environment;
 3


 encourages
diversity
initiatives;
frequently
displays
behavior

that
respects
and
values
individual
differences.



 Contributes
in
promoting
an
open
and
inclusive
environment;
 2


 participates
in
diversity
initiatives,
generally
displays
behavior

that
respects
and
values
individual
differences.



 Needs
encouragement
to
support
a
diverse
and
inclusive
 1


 environment;
fails
to
display
behavior
that
respects
and
values

individual
differences.

Needs
reminded
to
be
patient
and
to

work
well
with
others.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period





10. Attendance/Punctuality:
Consider
arrival
times,
observance
of
time
limits
for

breaks
and
lunches.

Consider
patterns
of
sick
leave,
prior
approval
for
vacations

and
prompt
notice
of
absence
due
to
illness.

Consider
the
employee’s
efforts

towards
ensuring
that
their
absence
will
not
disrupt
the
normal
flow
of
business.


Does
the
employee
use
their
PTO
in
ways
to
promote
a
balanced
work
and

personal
life
to
support
emotional
and
physical
health.




Selection
 Description/Explanation
 Rating


 Consistently
regular
in
attendance
and
extremely
punctual.

 4


 Provides
ample
notice
of
requests
for
PTO.

Adjusts
schedule
to


 work
needs.

Ensures
others
are
prepared
to
perform
necessary

tasks
during
PTO
minimizing
the
impact
of
their
leave.

Able
to

resume
from
their
time
off
in
an
orderly
and
effective
manner.


PTO
is
used
in
a
balanced
and
strategic
way.


 Consistently
regular
in
attendance
and
typically
punctual.

 3


 Attempts
to
ensure
tasks
are
completed
prior
to
leaving.

Relies

on
others
to
ensure
job
is
performed
during
their
leave
without

providing
necessary
guidance.

PTO
is
well
managed.


 Fairly
regular
in
attendance
and
typically
punctual.
Sometimes
 2


 provides
short
notices
regarding
requests
for
PTO.


Fragments


 the
use
of
their
PTO
making
it
difficult
to
cover
their
work
and

at
times
creates
hardships
for
other
staff.

Goes
on
leave

without
preparing
others
and
expecting
that
their
work
will
just

“get
done.”


PTO
is
managed
fairly
well.






 Frequently
calling
in
and
missing
work.

Routinely
uses
PTO
as
 1


 fast
as
it
is
earned
creating
hardships
for
other
staff
and
teams.




 Work
that
was
to
be
done
prior
to
using
PTO
for
vacation
is

often
left
incomplete.

Seldom
has
enough
PTO
to
take
an

appropriate
time
off
in
one
segment
to
support
emotional
and

physical
health.

Unpaid
days
often
occur
due
to
a
lack
of
PTO.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period




11. Employee
Management
(Supervisors
Only):
The
employee’s
use
of

appropriate/effective
management
style,
leadership,
flexibility,
care,
and
concern

for
total
employee.




Selection
 Description/Explanation
 Rating


 Excels
in
supervision
and
leadership
of
subordinates;
 4


 encourages
employees
to
develop
to
their
fullest
potential;


 coaches
and
trains
employees
for
advancement;
provides

honest,
ongoing
feedback
to
employees.


Evaluations
are

completed
on
time,
with
excellence,
extra
care
and
provide

clear
direction
to
employees.


 Provides
better‐than‐average
supervision
and
leadership
of
 3


 subordinates;
encourages
employee
development;
coaches
and


 trains
employees;
provides
honest,
ongoing
feedback
to

employees.

Evaluations
are
completed
on
time
and
are

prepared
appropriately
providing
clear
direction
to
employees.


 Provides
effective
supervision
and
leadership
of
subordinates;
 2


 encourages
development;
does
some
coaching
and
training;


 provides
feedback
periodically.

Evaluations
are
completed
on

time,
prepared
appropriately
and
provide
direction
to

employees.


 Provides
little
or
no
supervision
and
leadership
of
subordinates;
 1


 does
not
encourage
development;
does
not
coach
or
train

subordinates;
provides
little
feedback.

Evaluations
are

completed
in
a
less
the
acceptable
manner.

Comments/Performance
Examples:
 



Current
rating
of
 indicates:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period









12. Overall
Evaluation:
Consider
the
performance
of
the
employee
over
the
entire

review
period
and
select
one
of
the
following
ratings.



Selection
 Description/Explanation
 Rating


 Clearly
outstanding
 4


 Above
expectations
 3


 Meets
expectations
 2


 Needs
improvement
 1

Comments/Performance
Examples:




Previous
total
rating
of
 / 
compared
to
a
total
current
rating
of

/ 

indicates
an
average
rating
of
 which
is:



For
90/180
day
review,
the
supervisor
will
mark
one
of
the
following
based
on
the

employee’s
interview,
question
responses
and
resume:

Exceeds
initial
expectations

Consistent
with
initial
expectations

Low
than
initial
expectations



For
annual
reviews,
HR
will
mark
one
of
the
following:

Improvement
from
the
previous
review
period

Consistent
with
the
previous
review
period

Regression
from
the
previous
review
period









 

PART
IV
–
Goal
Accomplishment
During
the
Review
Period

Part
IV
will
be
initiated
in
advance
by
HR
who
will
summarize
the
goals
from
the

previous
review
period
or
the
employee’s
job
requirements
when
a
previous
review

has
not
been
performed.

The
supervisor
will
then
be
required
to
rate
the
employee

accomplishments
towards
the
goals
and
objectives
in
advance
and
then
review
and

discuss
the
ratings
during
the
formal
review
process.

Please
respond
to
each

question
with
a
rating
of
1,
2,
3
or
4
where
1
would
be
a
low
rating.

Comments
are

encouraged,
especially
for
ratings
of
1
and
4.



A
rating
of
a
‘4’
indicates
that
the
goal/objective
was
accomplished
at
an
outstanding

level
without
impacting
the
accomplishment
of
other
goals/objectives.

Assistance

beyond
what
was
anticipated
with
the
goal/objective
was
not
needed.

The
initial

completion
and
success
criteria
were
met.



A
rating
of
a
‘3’
indicates
that
the
goal/objective
was
accomplished
with
impact
to
the

accomplishment
of
other
goals/objectives.


Assistance
beyond
what
was
anticipated

with
the
goal/objective
was
not
needed.

The
initial
completion
and
success
criteria

were
met.



A
rating
of
a
‘2’
indicates
that
the
goal/objective
was
accomplished.

Additional

assistance
beyond
what
was
anticipated
was
provided
or
the
completion
date
and

success
criteria
were
adjusted
with
supervisor
approval.



A
rating
of
a
‘1’
indicates
that
the
goal/objective
was
not
satisfactorily
accomplished.



A
rating
of
‘N/A’
indicates
that
the
goal/objective
was
determined
to
no
longer
be

applicable
to
this
reporting
period
per
the
employee’s
direct
supervisor;
or,
the

goal/objective
was
re‐assigned
to
another
employee.






Note:
For
new
hires,
HR
will
attach
the
employee’s
offer
letter,
job
description
job

posting,
resume,
and
questionnaire
responses.

For
all
employees,
HR
will
attach
the
employee’s
absentee
report
for
the
reporting

period.



Goals
from
the
Last
Review
Period
or
the
Initial
Job
Offer:



Description
 Priority
 Rating


Total
Rating

 / 


 Average
Score









Summary
of
Major
Accomplishments
during
the
Review
Period:

(In
this
section
the
supervisor
should
highlight
the
accomplishments
of
the

employee) 

















Learning
Opportunities/Areas
for
growth:

(In
this
section
the
supervisor
should
make
constructive
suggestions
for

improvement) 



 

PART
IV
–
Future
Goals
and
Objectives



Description
 Priority






Acknowledgements:

My
signature
acknowledges
that
I
have
reviewed
this
document
and
discussed
the

contents
with
my
supervisor.

I
have
been
advised
of
my
performance
status
and
I

understand
that
all
comments
or
feedback
related
to
this
performance
review
should

be
documented
and
attached
to
this
document.

It
does
not
necessarily
mean
that
I

agree
with
all
of
the
contents.

I
understand
that
I
may
attach
written
comments
or

send
comments
directly
to
the
HR
department
if
desired.

All
comments
will
be

reviewed
by
HR
and
the
immediate
supervisor.


Employee’s
Signature:

_________________________
 
 Date:
_________




Immediate
Supervisor’s
Signature:



____________________
 Date:

_________

I
have
been
the
employee’s
supervisor
for
 years
and

months.



President/CEO
Signature:
_________________________ Date:

_________







FOR
HR
PURPOSES
ONLY

Were
there
employee
documented
comments
or
feedback?

Yes/No

All
feedback
related
to
the
performance
review
must
be
attached