All employees who are not represented by a union and their supervisors should complete this form.

Instructions:
Employee: Insert your name in the footer below and complete the “Employee” self-assessment sections (tan
color) to document your most notable accomplishments and impact in this performance year. Use of bullet
points is strongly encouraged. If certain sections are not applicable to you, leave them blank. For additional
information, see the Guidance sheet available on the Performance Management website (click on “Performance
Management” in the A-Z Index).

Supervisor: Complete the “Supervisor” sections (blue color) and provide a rating in the “Overall Rating” section.
Provide evaluative comments on the employee’s overall performance, most notable accomplishments and
impact, and areas for development and improvement, if any. Use of bullet points is strongly encouraged. For
additional information, see the Guidance sheet available on the Performance Management website.

Name: Ann XXX Division/Dept: XXX

Employee ID: XXXXXXX Job code: XXX
Job title: Staff Scientist/Engineer Date prepared: June 10, 2017
Supervisor: Marianne XXX
Period covered from: July 1, 2016 Period covered to: June 30, 2017

For Performance Year Being Reviewed

1a. Employee Goals
Employee: List the goals you needed to accomplish in this performance year, including:
● Performance goals: position expectations and goals
● Job development goals: skills or development needed in order to achieve performance goals
● Career development goals: broader goals for your long-term learning and growth (optional)
Performance goals:
• Conduct laboratory and field research regarding the role of advanced energy efficient technology in climate
change.
• Present research results in peer-reviewed literature and scientific meetings.
• Lead and manage my work group.
• Maintain clean, safe laboratory and ensure that work group members adhere to EH&S guidelines; ensure that
visiting researchers and students work safely as well.
• Complete Phase I of advanced energy efficient technology study for DOE by [Date].
• Publish at least three research papers.
• Develop new advanced technology programs and proposals; build collaborative efforts with other
researchers.
Job development goals:
• Serve as editor for a top-tier journal.
• Serve as conference chair for a high-profile organization.
1b. Employee Goals
Supervisor: Indicate whether you agree with the goals listed for this performance year. Provide input or list

Employee ---- Ann XXX

Annual Performance Review Summary 3/19/17 1

additional goals as needed.

I agree with Ann’s list of goals.

2a. Performance Summary

Employee: Describe your most significant accomplishments and impact in relation to your performance goals.
Also describe improvements you made on any performance issues that you and your supervisor discussed this
year.
My accomplishments summarized below made a strong contribution to our Division goal of $XXX in new funding
and being a leading institution in the area of XX in energy efficient technology:
• Completed Phase I of research on advanced energy efficient technology. Due to success of research results,
obtained $XXX in new funding from DOE to continue this work.
• Successfully researched the interactions between Type 1 advanced technology and other approaches to
increasing energy efficiency.
• Collaborated on proposals with the following researchers:
− [LBNL researcher name]: benefit of Type 2 advanced technology.
− [LBNL researcher names]: advanced technology for commercial building control systems.
− XXX University: study of climate impacts of Type 3 advanced technology in California.
− XXX College: contamination of technology deployed in field studies in area with severe air pollution;
published article.
− XXX University: performance properties of advanced technology under extreme climate conditions.
− XXX College: variability of the performance of advanced energy efficient technology in a residential
neighborhood.
I also made the following additional contributions:
• Published five research papers this year, plus have one at press and four in review.
• Assisted Jane XXX in obtaining a postdoctoral fellowship to research the effect of advanced technology on
energy usage.
• Regularly conducted performance conversations with staff; several have improved their performance, resulting
in early completion of DOE study.
• Brought in outstanding talent, in particular two emerging young scientists in this research field, each of whom
turned down offers at prestigious universities to come to LBNL.
2b. Performance Summary
Supervisor: Evaluate the employee’s performance, top achievements, and areas for development including:
● Overall statement on the employee’s performance this year, particularly in relation to goals.
● Four to six most significant accomplishments and impact.
● Improvements made on any performance issues that you and the employee discussed this year, and the
most critical areas to focus on for the coming year.
Ann has made an excellent contribution to the Laboratory. Her efforts have not only helped our Division to meet its
research goals in the field of energy efficiency, but have also helped the Laboratory to emerge as a national leader
in this field, which is attracting new funding and talented researchers.
I agree with the accomplishments that Ann listed on her Self Assessment. In addition, I would like to add that:
• Ann took the initiative to meet difficult deadlines and was very strategic and diligent in soliciting the right
collaborators to enable completion of Phase I of her research on advanced energy efficient technology. She also

Employee ---- Ann XXX

Annual Performance Review Summary 3/19/17 2

 managed the project within budget by developing cost-effective solutions to the problems that arose.
• She received considerable outside recognition for the project, which exceeded expectations, including being
asked to chair the Advanced Energy Efficient Technology International Conference and invited to be a member
of the American Physical Society.
• She used her position as conference chair to further establish herself as a leader in her field and to extend and
build new relationships with scientists with potential for collaborations in related fields. While no specific new
research project has emerged yet, she is taking the initiative to build the knowledge, diversity of relationships,
and the scientific accomplishments and recognition needed to attract new research collaborations for her in the
future.
• She used her position as editor as an opportunity to learn about cutting-edge research and the scientists
involved in related fields and disciplines beyond her own.
• Her excellent relationship building skills and activities have enabled her to bring in two prestigious collaborators
to her research and to explore other related new research areas.
3a. Areas of Strength 4a. Areas for Development (or Improvement)
Employee: List several of your most valuable strengths. Employee: List several areas where you need further
development.
• Networking • More exposure to potential outside
• Collaboration collaborators
• Productivity
• Expand management skills
3b. Areas of Strength 4b. Areas for Development (or Improvement)
Supervisor: Indicate whether you agree and add your Supervisor: Indicate whether you agree and add your
own perspective. own perspective.
I agree with Ann’s list and would like to add: I agree with Ann’s list and would like to add:
• Very focused, very productive • Pursue new opportunities to further build on
• Collaborative: established strong relationships her collaborative strengths and develop
with scientists at other institutions additional relationships, such as chairing
• Strategic: has been of great help in trying to other conferences and speaking at scientific
establish strong relationships with the DOE meetings.
• Supervisory skills are excellent; she clearly and • Further develop her team management skills,
regularly communicates her vision and goals to particularly since being the PI for multiple
her staff within the broader context of Division groups is relatively new for her.
and Laboratory goals • Improve on skills to develop, motivate and
manage a higher-caliber group of staff to
support the group’s research directions.
5a. Safety
Employee: Describe your efforts this year to enable a positive safety culture at work and to protect yourself,
team, division, Laboratory and public. Include accomplishments related to identification, evaluation, control,
prevention, and/or mitigation of potential hazards. Also indicate if you participated in any of the Laboratory’s
opportunities to improve safety (e.g., Division/Laboratory Safety Committee, “safety minute” presentations in
meetings, ergonomic advocate program, fire extinguisher use and/or first aid training, employee volunteer
responder programs such as Building Emergency Team (BET) and Community Emergency Response Team
(CERT)).
• Ensured that both I and my staff completed all required safety training; conducted regular discussions with staff
and visiting researchers and students to review safety standards.
• I am committed to a safe environment; reviewed safety standards and inspected work area on an ongoing basis.
• For internal staff for whom English is a second language, I supplemented Laboratory safety training with weekly
one-on-ones on safety for the first month to ensure they understood Laboratory procedures.

Employee ---- Ann XXX

Annual Performance Review Summary 3/19/17 3

5b. Safety
Supervisor: Indicate whether you agree and whether the employee has met your expectations for safety. Add
comments if necessary.
I agree with Ann’s description of the safety programs she has taken and her level of commitment to safety. In
addition, when a near miss happened in Ann’s laboratory last February, she took immediate actions and revised
procedures to ensure it would not happen again. Her quick and thorough response was highlighted as a model in
a Division All Hands meeting.
6a. Diversity and Inclusion
Employee: Describe how you contributed to and/or participated in diversity and inclusion activities in your
Division or for the Laboratory. Some examples may be (but are not limited to): ensured staff/everyone in meeting
had opportunity to share his/her perspective; solicited diverse perspectives on issue from staff/others; attended a
job fair, diversity conference or event; participated in a diversity council, focus group, implicit bias training,
selection committee, Employee Resource Group; etc.
• Served on XXX Lab-wide Committee
• Served on XXX search Committee
• Attended XXX diversity Conference
6b. Diversity and Inclusion
Supervisor: Indicate whether you agree and/or provide evaluative comments.
I agree with Ann’s comments.

7a. Supervisory/Host Responsibility

Employee: If applicable, indicate the number of individuals you directly supervise or host in each category.
4 Postdoctoral fellows and scientists
3 Research associates and technicians, etc.
2 Graduate students
Affiliates (Guests)
Supervisors
Operations and administrative employees
7b. Supervisory/Host Performance
Employee: If applicable, summarize your performance as a supervisor. Include your efforts: to ensure that
employee performance and conduct adhere to applicable requirements and policies, and to encourage employee
development.
I conduct performance conversations with all staff members at least quarterly, and am actively working with them
on job development activities.
7c. Supervisory/Host Performance
Supervisor: If applicable, indicate whether you agree and/or provide evaluative comments.
I agree with Ann’s comments. I have received feedback from her staff that she conducts regular performance
conversations and is always very clear on goals and setting reasonable milestones.
8a. Laboratory, Professional and Community Service
Employee: Briefly describe your laboratory/university/professional/community service and/or committee work.
Laboratory Service
• Chaired XXX Division Committee
Professional Service
• Editor for the Journal of Advanced Energy Efficient Technology
• Chair of the Advanced Energy Efficient Technology International Conference held at LBNL

Employee ---- Ann XXX

Annual Performance Review Summary 3/19/17 4

• Provided technical advice over a six-month period to law firm regarding the nature and role of advanced
technology in energy efficiency
8b. Laboratory, Professional and Community Service
Supervisor: Indicate whether you agree and/or provide evaluative comments.
I agree with Ann’s comments.

9a. Publications, Reports

Employee: If applicable, list in order of significance, and cite only items not submitted on previous self-
assessments
• Order of citation information: author(s), year, title, journal, DOI

Journal Articles: Published, Accepted, or In Press (include DOI):

Refereed journals:
• [Title] (2016) [Authors], Journal of Advanced Energy Efficient Technology, XX, XXXX. LBNL-XXXX
• [Title] (2016) [Authors] Transactions of the International Society of Energy Efficient Technology, XX, XXXX. LBNL-
XXXX
• [Title] (2016) [Authors] Energy Efficient Technology Review Letters, XX, XXXX. LBNL-XXXX
• [Title] (2017) [Authors] Journal of Advanced Energy Efficient Technology, XX, XXXX. LBNL-XXXX
• [Title] (2016) [Authors] Journal of Climate Change Mitigation, XX, XXXX. LBNL-XXXX
Other articles:
[Title] (2016) [Authors] Energy Efficient Sci. Technol., in press. LBNL-XXXX
Journal Articles: Submitted, In review, etc.:

Other published works (e.g. book chapters, published reports, etc.):

[Title] (2016) [Authors] Energy Efficient Sci. Technol., in press. LBNL-XXXX
9b. Publications, Reports
Supervisor: If applicable, provide evaluative comments on the employee’s accomplishments, and identify areas
for improvement.
I agree with Ann’s comments in this section.

10a. Invited Talks and Conferences

Employee: If applicable, list invited talks and conferences in this performance year.
• Order of citation information: author(s), year, title, meeting/conference name, date(s)

Invited, keynote or plenary presentation (at nationally/internationally recognized professional scientific

meetings/forums, as a university distinguished seminar, etc.)
Invited to join the American Physical Society.

Contributed oral or poster presentation at professional scientific meetings or forums

10b. Invited Talks and Conferences

Supervisor: If applicable, provide evaluative comments.
I agree with Ann’s comments in this section.

11a. Proposals Funded or Submitted, and Active Projects:

Employee: If applicable, list proposals funded or submitted, and current projects which received funding during

Employee ---- Ann XXX

Annual Performance Review Summary 3/19/17 5

this review period. This includes projects where you have financial oversight, however may not be the PI (add
more rows, if necessary).
Type of Proposal Sponsor Annual Amount Role in Project Funded (F) or
You Manage PI/Co-PI /Senior Submitted (S) or
Personnel Ongoing (O)
XXX DOE XXX PI F
XXX XXX University XXX Co-PI F
XXX XXX Federal XXX Co-PI S
Agency
11b. Proposals Funded or Submitted
Supervisor: If applicable, provide evaluative comments on the impact of the funded proposals.
I agree with Ann’s comments in this section.

12a. Knowledge and Technology Transfer

Employee: If applicable, cite accomplishments in the following areas that have occurred during this review period.
Cite only those not submitted on previous self assessment.
● Knowledge and/or technology transfer accomplishments, such as intellectual property, patents, software
releases etc. Describe significance of top accomplishment/s.
XXX patent, 2016

12b. Knowledge and Technology Transfer

Supervisor: If applicable, provide evaluative comments on the employee’s accomplishments, and identify areas
for improvement.
I agree with Ann’s comments.

13a. Awards and Honors

Employee: If applicable, provide award name and brief description, including how selection was made.
N/A

13b. Awards and Honors

Supervisor: If applicable, provide evaluative comments on the importance of these accomplishments.
N/A

For Next Performance Year

14a. Employee Goals
Employee:
List your recommended goals for the next performance year, including:
● Performance goals: position expectations and goals
● Job development goals: skills or development needed in order to achieve performance goals
● Career development goals: broader goals for your long-term learning and growth (optional)

See Next Steps below for directions on how to submit at pmp.lbl.gov.

Performance goals:
• Complete Phase II of Type 1 advanced technology for DOE by November [date].
• Complete research for XXX Federal Agency on performance properties of advanced technology for climate

Employee ---- Ann XXX

Annual Performance Review Summary 3/19/17 6

 change mitigation by [date].
• Complete XXX Federal Agency climate impact study of advanced technology by [date].
• Complete Phase I of XXX State Agency study by [date].
Job development goals:
• Attend Berkeley Lab Learning Institute supervisor workshop to enhance my skills in developing and managing
my staff. Investigate other learning and development resources to improve my performance management skills.
• Talk to Division Director about nominating me to participate in Laboratory’s Deputy & Department Head
Leadership Development Program.
14b. Employee Goals
Supervisor: Indicate whether you agree with the goals listed, and/or add or revise goals as needed.
I agree with the goals that Ann listed on her Self Assessment. I would like to add the following:
Performance goals:
• Obtain $XXX to upgrade laboratory equipment for energy efficiency research projects by pursuing DOE funding
and looking for additional opportunities at other agencies.
• Foster new working relationships with scientists at XX and XX universities to broaden research activities and
increase opportunities in related and emerging areas of research in her field.
Job development goals:
• Accompany Division Director to Washington, D.C. for in-person meetings with program managers for funding
research in the energy field.
• Participate in a Division committee to research and review safety practices and make recommendations to the
Division Director.
15. Laboratory, Division or Group Goals
Supervisor: List the broader institution and/or research goals the employee needs to support in the next
performance year, if available and relevant to the employee’s job.

See Next Steps below for directions on how to submit at pmp.lbl.gov.

Division goal:
• Advance the Laboratory’s Carbon Cycle 2.0 strategy by broadening the Laboratory’s research and reputation in
emerging fields of energy efficient technology.
Group goal:
• Successfully conduct laboratory and field research regarding the role of advanced energy efficient technology in
climate change.
• Secure at least two collaborations that will secure the Laboratory’s leadership role and funding for an emerging
area of energy efficient technology.

Employee ---- Ann XXX

Annual Performance Review Summary 3/19/17 7