2 Performance Appraisals Rating Standards 2 EXEEDS STANDARDS­The employee shows unusual initiative and makes suggestions that lead the organization, team, or unit in directions that benefit the company. Within the level of this position, this employee’s performance has moved the company to a new level of understanding, action, or results that are valuable to the organization’s future. The employee’s major projects- even the difficult ones or ones he/she has initiated- have achieved better results than expected in timeliness, cost, quality, and service measures. The employee demonstrates high competence (knowledge, skills, ability, experience) and high commitment (motivation and self-confidence). Because of specific past performance, the employee has built a reputation among management and colleagues as an expert in her/his job arena. The employee takes on extra projects and tasks without defaulting on other assigned activities. The employee does her/his own advance planning, anticipates problems, and takes appropriate action. Her/his performance requires only occasional supervision and follow-up. The employee invariably chooses effective and efficient approaches to getting the job done. 1 MEETS STANDARDSThe employee is doing a complete and satisfactory job. Performance is what is expected of a fully qualified and experienced person in the assigned position. The employee has achieved the results expected.The employee’s performance does not require significant improvement in major job areas. Improvement in skill maturity or experience may be desirable, but does not constitute a performance problem. This employee receives mostly positive comments from others with whom the employee works. This employee fosters work relationships that are productive.This employee benefits from supervision and follow-up and usually completes regular work and projects on schedule. Directive supervision and follow-up may be necessary when goals and projects are new or difficult. With direction, the employee uses effective and efficient approaches to getting the job done. The employee has experienced all of the job responsibilities of the position and is capable in each. 0 DOES NOT MEET STANDARDS The employee has done satisfactory work in some job areas, but needs improvement in other areas to do a complete and satisfactory job.The employee is on a plan to improve job areas. The employee may not yet have experienced all the job responsibilities of the position because he/she has not mastered the initial ones. He/she has been on the job long enough to have shown better performance. Co-workers have to pick up some of the employee’s workload until he/she is capable of being successful in all of the job responsibilities. The employee’s work in important job areas sometimes falls behind.The employee has not done satisfactory work in important job areas Self Evaluation Employee Name:_________________________________________ Date:___________ ...

1. 2
Performance
Appraisals
Rating Standards
2 EXEEDS STANDARDS-The employee shows unusual
initiative and makes suggestions that lead the organization,
team, or unit in directions that benefit the company. Within the
level of this position, this employee’s performance has moved
the company to a new level of understanding, action, or results
that are valuable to the organization’s future.
The employee’s major projects- even the difficult ones or ones
he/she has initiated- have achieved better results than expected
in timeliness, cost, quality, and service measures.
The employee demonstrates high competence (knowledge,
skills, ability, experience) and high commitment (motivation
and self-confidence).
Because of specific past performance, the employee has built a
reputation among management and colleagues as an expert in
her/his job arena.
The employee takes on extra projects and tasks without
defaulting on other assigned activities.
The employee does her/his own advance planning, anticipates
problems, and takes appropriate action. Her/his performance

2. requires only occasional supervision and follow-up.
The employee invariably chooses effective and efficient
approaches to getting the job done.
1 MEETS STANDARDSThe employee is doing a complete
and satisfactory job. Performance is what is expected of a fully
qualified and experienced person in the assigned position. The
employee has achieved the results expected.The employee’s
performance does not require significant improvement in major
job areas. Improvement in skill maturity or experience may be
desirable, but does not constitute a performance problem. This
employee receives mostly positive comments from others with
whom the employee works. This employee fosters work
relationships that are productive.This employee benefits from
supervision and follow-up and usually completes regular work
and projects on schedule. Directive supervision and follow-up
may be necessary when goals and projects are new or difficult.
With direction, the employee uses effective and efficient
approaches to getting the job done. The employee has
experienced all of the job responsibilities of the position and is
capable in each.
0 DOES NOT MEET STANDARDS The employee has done
satisfactory work in some job areas, but needs improvement in
other areas to do a complete and satisfactory job.The employee
is on a plan to improve job areas. The employee may not yet
have experienced all the job responsibilities of the position
because he/she has not mastered the initial ones. He/she has
been on the job long enough to have shown better performance.
Co-workers have to pick up some of the employee’s workload
until he/she is capable of being successful in all of the job
responsibilities. The employee’s work in important job areas
sometimes falls behind.The employee has not done satisfactory
work in important job areas
Self Evaluation
Employee
Name:_________________________________________

3. Date:________________
Please complete the following questionnaire, as it will assist in
the completion of your evaluation and return to
_________________________ no later than
____________________What do you consider to be your most
important work related accomplishment in the past 12 months?
_____________________________________________________
_____________________________________________________
______________________What is your favorite part of your
job? Why?______________________________________
_____________________________________________________
_____________________________________________________
______________________At work I have the opportunity to do
what I do best everyday.
Strongly Agree Agree Disagree
Strongly Disagree
Explain______________________________________________
_____________________________________________________
_____________________________________________________
_________________________________________How have you
positively impacted the customers experience at our
organization within the last 90 days?
_____________________________________________________
_____________________________________________________
_____________________________________________________
__________________________________________
How is the work you are doing today contributing toward your
professional growth and development?
_____________________________________________________
_____________________________________________________
_____________________________________________________
__________________________________________
What can you do to make your work environment better and
more efficient for yourself and those around you?
_____________________________________________________
_____________________________________________________

4. _____________________________________________________
__________________________________________
Performance Appraisal
Name:_________________________________
Appraiser:____________________________________
Today’s Date:_____________ Job Title:___________________
Dept:____________________________
Review: Annual 90 Day
Other:______________________________________
2 Exceeds Expectations 1 Meets Expectations 0 Does Not
Meet Expectations
Job Performance
____ Meets competency requirements listed in job specific
competency checklist (Insert Competency Checklist Score)
___ Meets Department productivity standards.
____ Follows through on commitments without reminders from
the manager.
____ Is willing to adjust to changing without reminders from
the manager.
____ Demonstrates a consistent level of performance.
Comments:___________________________________________
_____________________________________________________
_____________________________________________________
______________________________________________
Teamwork
____ Contributes to positive morale by looking for and
suggesting ways to chare workload.
____ Encourage and recognizes coworkers for their efforts
verbally and in writing (rave-reviews)
____ Completes assigned tasks as a team member and offers to
help others succeed in their assigned tasks
____Communicate with other team members and

5. receives/utilizes feedback from team positively.
____ Demonstrates good listening skills when conflict and
misunderstandings arise.
Comments:___________________________________________
_____________________________________________________
_____________________________________________________
______________________________________________
Attendance/Punctuality
____Has missed time from work on less than 5 separate
occasions (excluding most leaves).
____ No unexcused absences during evaluation period.
____Follows Proper call-in procedure when not able to come to
work.
____ Attends inservices and meetings when requested and
arrives at work on time.
Comments:___________________________________________
_____________________________________________________
_____________________________________________________
______________________________________________
Customer Service
____Anticipate Internal/external customer needs and takes
action to meet those needs.
____ Handles high volumes without losing customer service
attitude.
____ Handles confidential information and situations correctly.
Does not gossip.
____ Acts in ways that build trust with customers (Coworkers,
patients, family…).
____ Relates to people in an open, friendly, and accepting
manner by smiling, greeting others, and responding to
greeting from others.
Comments:___________________________________________
_____________________________________________________
_____________________________________________________
______________________________________________
Safety & Education

6. ____ Attends mandatory annual training within correct
timelines
____ No injuries due to unsafe practices
____ Follows safety guidelines.
____ Shows initiative to increase professional knowledge and
skills
____ Takes ownership of safety or service issues and fixes them
or forwards them appropriately.
Comments:___________________________________________
_____________________________________________________
_____________________________________________________
______________________________________________
Visionary/Future Thinking
____ Encourages new ideas and process improvement
____ Accepts change positively without complaints.
____ Takes the initiative to teach, coach, and mentor fellow
team members in a affirming and positive way.
Comments:___________________________________________
_____________________________________________________
_____________________________________________________
______________________________________________
Performance Objectives
____Participated in determining performance objectives and
timelines
____ Met timelines associated with performance objectives.
____ Communicated with manager on status of performance
objectives, including needs and obstacles.
____ Achieved performance objectives (disregard goal areas
that became unrealistic to accomplish during year).
Comments:___________________________________________

7. _____________________________________________________
_____________________________________________________
______________________________________________
Performance Appraisal Summary
Job Performance: __________ Safety &
Education __________
Teamwork: __________
Visionary/Future Thinking: __________
Attendance/Punctuality: __________ Performance
Objectives: __________
Customer Service: __________
Employee Comment:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________
Appraiser’s
Signature_____________________________________
Date________________
Employee
Signature______________________________________
Date________________
Director/Manager

8. Signature_______________________________
Date_________________
Human Resources
Review_________________________________
Date_________________
(Employee’s signature means the performance appraisal was
reviewed with him/her. It does not necessarily indicate that
s/he agrees with the appraisal.)
Performance Objectives
Current Year
Employee Name:
___________________________________________________
Date:____________________
Performance Objective:
Timeline:
Plan for Completion:
Performance Objective:
Timeline:
Plan for Completion:
Performance Objective:
Timeline:
Plan for Completion:
Performance Objective:

9. Timeline:
Plan for Completion:
Employee
Signature:____________________________________________
____ Date:____________________
Manager
Signature:____________________________________________
_____ Date:____________________
Performance Objectives
Future year
Employee Name:
___________________________________________________
Date:____________________
Performance Objective:
Timeline:
Plan for Completion:
Performance Objective:
Timeline:
Plan for Completion:
Performance Objective:
Timeline:
Plan for Completion:
Performance Objective:
Timeline:
Plan for Completion:

10. Employee
Signature:____________________________________________
____ Date:____________________
Manager
Signature:____________________________________________
_____ Date:____________________