1.
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.

2.
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?

3.
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.

4. 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

5. 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

6.
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

7.
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

8.
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

9.
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

10.
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

11.
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

12.
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

13. 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

14.
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

15.
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

16.
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.

17. 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)

18.
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