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Performance Appraisal Form

March 10, 2008

This sample Performance Appraisal form is a confidential, handwritten report based on a meaningful two-way discussion with the employee. It uses a 5-number rating system, where 1 is the strongest and 5 is the weakest rating. This form is used to assess dependability, interpersonal relationships, job performance, initiative, job knowledge, attendance and punctuality, support of company policies, as well as safety guidelines, goals (previous, current, and future), overall job performance rating, and the employee’s own review and comments, among other skills.

Performance Appraisal

Confidential

Performance Record for (Name):__________________________________________________________

Division/Department:___________________________ Location:________________________________ Title:________________________________________________________________________________ Reporting Period:_______________________________ Today’s Date:____________________________ Employment Date:____________________ Reviewer’s Name:__________________________________

Performance Appraisal

Guidelines:

People development requires a supervisor’s objectivity and willingness to discuss programs, plans, and attitudes openly and positively. This confidential, handwritten report should be the basis for a meaningful, two-way discussion with the employee. The ensuing performance discussion can be most successful when this report is thoughtfully and accurately completed. Please advise your Human Resources/Personnel department if assistance would be helpful—before or after the performance discussion. Where narrative is required, please provide quantitative data and specific examples, whenever possible. Feel free to attach additional sheets, job descriptions, proposed revisions, or other information. Precede verbal comments with the corresponding number from the Rating Guide.

Rating Guide:

1 = Distinguished—Conspicuously meritorious performance. Consistently exceeds all requirements.

2 = Superior—Generally exceeds requirements with a minimum of guidance. Well above average performance.

3 = Competent—Responsibilities met in a wholly satisfactory manner. Normal guidance and supervision are required.

4 = Marginal—Improvement needed in some key job areas. Considerable guidance and supervision are required.

5 = Unsatisfactory—Major shortcomings in performance. Will require reassignment or separation if plans for progress are unsuccessful.

Form:

Amount of work accomplished    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Dependability (consistently counted on to get the job done)    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Interpersonal Relationships (effectiveness on the job dealing with people at all levels)    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Initiative—Self-Starter (seeks ways to complete assignments with minimum guidance)    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Knowledge of Job (consider relationship to length of time in assignment)    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Organization/Time Management    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Punctuality    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Attendance (within framework of flexible work schedule)    Score:___ Total days absent_______ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Quality of Work    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Support of/Involvement in company programs, including affirmative action    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Support of company safety programs and activities    Score:___ More info: ________________________________________________________________________________________ ________________________________________________________________________________________

Goal Analysis: Previously set goals that have been met (specify whether personal or departmental goals) ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Goals yet to be achieved (establish calendar quarterly timetable) ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Plans for next performance period: (include specific commitments to enable employee to perform at higher level of competence—specify needs, development activities, and timetables) ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Overall Performance Rating:    Total Score:___ General summary of performance and accomplishments: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________


Reviewer’s signature                                  Date ___________________________________________ Department Head signature                                 Date


Human Resources signature                                Date

Employee review and comments

This performance review has been reviewed with me:


Employee signature                               Date

Remarks: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

I request further discussion of this performance review: Yes      No

Date:__________________________________


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