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Custom Performance Appraisal Review Form

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Custom Performance Appraisal Review Form

  1. 1. Employee Performance Appraisal Form 1 Name: _____________________________________________ Date: _________ Employee ID: ___________ Dept.: ________________ Job Title: Staffing Coordinator Review Type: Quarterly Annual Special Review Period: ____/____/________ to ____/____/________ Completed by: ________________________________ Title: _________________________ This performance review follows the employees progress over the period assigned by the manager within this role. This review considers all of the elements of the position as well as how the employee has meet the assigned expectations. The goal of this review is to help the employee succeed in their career path with our organization. Section 1: Evaluation of Responsibilities This section reviews the employee’sperformance in performing their primary responsibilitiesthroughout the course of the review period. Ratings are based on data collection to evaluate performance. Comments provides are used as tools to help improve performance. Primary Responsibilities Ratings (highlight selection) Comments Providing customer service support to caregivers and clients: Respond to caregiver and client calls regarding services, ongoing needs, and other areas of importance. Must address all areas with patience, immediacy, and providethe necessary tools to accomplish a positive resolution. 1 2 3 4 5 Provide care assessments and enter into client contracts based on services required: Meet with families and define the services of the clients to ensure that it is something we can support and meets their financial needs. Once established, complete the contract and corresponding documentation for services required. 1 2 3 4 5 Meet with clients on a weekly basis to evaluate care and staff services: Ensure quality service and care for the clients through verbal and in person visits. Visits are to be documented for care review and assurance of state standards. 1 2 3 4 5 Meet with Agency Manager on a bi- weekly basis regarding caregivers and clients: Review weekly care with Agency Manager to address changes, successes, and areas of improvements. These meetings will also be used to plan areas to improveemployee relations and grow the team. 1 2 3 4 5 Supervise caregivers and handle all training and disciplinary actions: Manage all new hiring training, client specific training, and introduction of new regulation. Responsible for also connecting with employees on a weekly basis to support employee’s development, recognize their efforts, and address training concerns. 1 2 3 4 5
  2. 2. Name: _____________________________________________ Date: _________ 2 Supervise quarterly and annual trainings: Responsible for managing regulatory and agency mandated trainings, documenting employee accuracy, areas of improvements, and completion. 1 2 3 4 5 With the support of the Agency Manager, perform annual employee reviews: Meet with employee evaluating performance throughout the year, reviewing task completion, goals achievement, and plans for the coming year. 1 2 3 4 5 Review all care giver notes and timecards for accuracy and verification: Weekly basis review caregiver documentation and timecards to ensure accuracy of agency and regulatory compliances. 1 2 3 4 5 Perform a variety of administrative, data entry, and office support tasks: New client data entry and file preparation, biweekly timecard preparation, preparation of new marketing files, and other office tasks. 1 2 3 4 5 Provide direct care to patients when employees are unavailable: Available to directly care for clients when employees are unavailable to support care. Ensure that the quality of care normally provided is maintained. 1 2 3 4 5 Assist with lead generation and new client development: Must network with local senior organizations and trade shows to connect with potential new clients. Responsible for making new contacts weekly and developing strategies to capture new clients. 1 2 3 4 5 Section 2: Evaluation of Core Competencies This section reviews core performance aspects related to the position and future development. Core Competencies Ratings (highlight selection) Comments Communications: Able to provide clear and focused communications in verbaland written formats. 1 2 3 4 5 Problem Solving/Decision Making: Able to assess a situation and determine an appropriate response in a quick and efficient manner that benefits all parties. 1 2 3 4 5 Training Implementation: Presents learning materials in a concise manner as well as assesses learning to ensure employee development. 1 2 3 4 5 Time Management: Able to manage all responsibilities in a timely manner to meet agency and regulatory deadlines. 1 2 3 4 5 Quality Management: Ensures all communications and documents are presented in an organized and professional manner. 1 2 3 4 5
  3. 3. Name: _____________________________________________ Date: _________ 3 Leadership: Able to guide employees in a manner that benefits both the agency and employee’s growth. Willing to makedifficult decisions to meet agency and regulatory compliances. 1 2 3 4 5 Teamwork: Works well with other, accepting and providing support to attain organizational goals. 1 2 3 4 5 Accountability: Accepts responsibility for assigned tasks and work towards meeting expected goals. Manages responsibility and delegates tasks as necessary. 1 2 3 4 5 Relatable: Able to connect with others as an empathetic listener who can understand and acknowledge the feelings of others. 1 2 3 4 5 Goal Oriented/High Initiative: Able to define agency goals and set personal goals to obtain success. Acknowledges drawbacks and errors, capable of addressing concerns to quickly get back on track. 1 2 3 4 5 Section 3: Stakeholder Feedback (Peer, Client, and Self-Assessment Results) This section focuseson actual survey results fromstakeholders in relation to this position. While all results are summarized for ratings, the comments included are directly from survey reviews. Core Areas of Feedback Ratings (highlight selection) Comments Customer Service: Professionalism, presentation, and understanding of the situation. 1 2 3 4 5 Training and Support: Interactive, knowledgeable, and offers opportunities to develop skills. 1 2 3 4 5 Documentation Management: Keeps all documentation organized and easily accessible. 1 2 3 4 5 Conflict Resolution: Possesses exceptional skills to connect with others and find solutions that meet all parties’ expectations. 1 2 3 4 5 Responsiveness and Dependability: Able to respond to requests immediately and demonstrates follow through. 1 2 3 4 5
  4. 4. Name: _____________________________________________ Date: _________ 4 Section 4: Developmental Goals and Achievements This section evaluates results of developmental goals and accomplishments in achieving results. Developmental Goals Ratings (highlight selection) Comments 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Rating Guideline Explanations 1: Unsatisfactory Performance was below expectations in most assigned responsibilities and core competencies. Employee failed to properly support clients and employees, causing concerns for safety and incompliance with state regulations. Corrective action plan will be enacted to help employees improve their performance. 2: Needs Improvement Performance was inconsistent, with a failure to meet one or more assigned responsibilities or core competencies. While safety was not a concern, incompliance of state regulations is a problem. A professional development plan will be enacted to help employees improve their performance. 3: Satisfactory Accomplishes tasks as they are set out. Achieves goals and exceeds expectations in some areas. Quality of work is great but does not always exceed expectations in every area. 4: Exceeds Expectations Goes above and beyond to accomplish all responsibilities assigned. Presents a high level of knowledge relating to core competencies. Achieves all goals and supports others with also achieving their goals. 5: Exceptional Performs at an exceptional level, exceeding all expectations and acts as a resource for team members. Allows for projects to progress and defines methods of achieving greater success.
  5. 5. Name: _____________________________________________ Date: _________ 5 Section 5: Future Developmental Goals These goals are based on the accomplishments and results accumulated from the previous sections. These goals are created during the performance review process only. Goals Plan of Action Deadline Date Section 6: Comments This section must NOT be completed priorto the performance review meeting. These comments are to be freely offered and based on the results presented in the previous sections. Anything addressed is to help support employee’s performance and development. Manager’s Comments: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Employee’s Comments: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Employee Signature: ___________________________________ Date: _______________ Signing verifies that the employee received a copy of the review form only, not agreement to the results. Manager’s Signature: ___________________________________ Date: _______________ Human Resources Signature: _____________________________ Date: _______________ HR Name Printed: ____________________________________________

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