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PERFEVAL.FRM
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1992-02-01
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┌────────────────────────────────────────┬─────────────────────────────────┐ │ │ PERFORMANCE EVALUATION │ │ SECTION A: PERSONNEL INFORMATION └─────────────────────────────────┤ │ │ │ Employee Name: ______________________ Job Classification: ____________ │ │ │ │ Department: ______________________ Division: ______________________ │ │ │ │ Anniversary: ______________________ Period Covered: ________________ │ │ │ │ Completed Report Due: ___/___/____ Report Date: ___/___/____ │ │ │ ├──────────────────────────────────────────────────────────────────────────┤ │ │ │ SECTION B: TYPE OF REPORT │ │ │ │ ■ Annual ■ Special ■ Probationary(Status) ■ Probationary(final) │ │ │ ├──────────────────────────────────────────────────────────────────────────┤ │ │ │ SECTION C: EVALUATION FACTORS │ SECTION D: PERFORMANCE LEVELS │ │ │ │ │ C-1: MANDATORY FACTORS │ (Circle one for each factor)│ │ (Required for ALL Employees) │ │ │ │ │ │ 1. Adaptability │ 1 2 3 4 5 6 7 8 9 10 │ │ 2. Attendance │ 1 2 3 4 5 6 7 8 9 10 │ │ 3. Dependability │ 1 2 3 4 5 6 7 8 9 10 │ │ 4. Initiative │ 1 2 3 4 5 6 7 8 9 10 │ │ 5. Employee Relations │ 1 2 3 4 5 6 7 8 9 10 │ │ 6. Quality of Work │ 1 2 3 4 5 6 7 8 9 10 │ │ 7. Quantity of Work │ 1 2 3 4 5 6 7 8 9 10 │ │ 8. Work Habits │ 1 2 3 4 5 6 7 8 9 10 │ │ │ │ │ C-2: OPTIONAL FACTORS │ │ │ (Evaluate if appropriate) │ │ │ │ │ │ 1. Public Contact │ 1 2 3 4 5 6 7 8 9 10 │ │ 2. Planning & Organization │ 1 2 3 4 5 6 7 8 9 10 │ │ 3. Communications - Verbal │ 1 2 3 4 5 6 7 8 9 10 │ │ 4. Communications - Written │ 1 2 3 4 5 6 7 8 9 10 │ │ 5. Supervisory Ability │ 1 2 3 4 5 6 7 8 9 10 │ │ 6. Management Ability │ 1 2 3 4 5 6 7 8 9 10 │ │ 7. Other: ____________________ │ 1 2 3 4 5 6 7 8 9 10 │ │ 8. Other: ____________________ │ 1 2 3 4 5 6 7 8 9 10 │ │ │ ├──────────────────────────────────────────────────────────────────────────┤ │ │ │ SECTION E: EVALUATION POINT TOTAL │ │ │ │ EXCELLENT ------------------ 9.8 to 10 │ │ VERY GOOD ------------------ 7.6 to 9.7 (Divide total score │ │ Satisfactory --------------- 4.8 to 7.5 by number of │ │ Improvement Needed --------- 2.8 to 4.7 factors evaluated) │ │ Unsatisfactory ------------- 1.0 to 2.7 │ │ │ └──────────────────────────────────────────────────────────────────────────┘ SCORE: _________ OVERALL EVALUATION:_______________________________