STAFF EVALUATION FORM
Mission
Improving the lives of children through excellence in advocacy, education, research and clinical care.
Employee General Information
/ Type of Evaluation (check one):Name: / □ Annual
Job Title: / □ 5 Month (Near end of Probation, Transfer)
Division/Program: / □ 3 Month (Mid-Probationary, Transfer)
Evaluator: / □ Other (please specify)
Review Period:
Rating Categories
Ø Needs Improvement – Performance does not consistently meet standards or requires further development. Requires frequent instruction and supervision. This rating requires supporting comments.
Ø Met Standard - Performs correctly and meets standards consistently. Occasionally requires instruction and supervision. Comments are recommended.
Ø NOTE: If the employee exceeds the standard, this can be reflected in the comments section. An employee that exceeds standards performs correctly and consistently above standards, and is a role model for others to emulate.
PART I - Behavioral Standards – Core Behaviors: The supervisor should complete this section prior to meeting with the employee.
Professionalism – Accepts responsibility for own actions and decisions; represents the department in a professional manner; challenges the issue and not the person; makes and keeps agreements; maintains confidentiality; respects the opinions, choices, and rights of others; and respects professional boundaries.
Actual Performance (Comments, Examples): / Met Standard
Needs Improvement
Teamwork - Knows when to seek help; willingly offers to help others; communicates effectively with others; works effectively with others; supports decisions made by the group; demonstrates professionalism and flexibility in response to changing circumstances; shares knowledge and information with others as appropriate; and takes ownership for assignment completion and service.
Actual Performance (Comments, Examples): / Met Standard
Needs Improvement
Improvement - Identifies areas for improvement; suggests solutions for improvement; works to improve individual performance; and works to increase skills and knowledge.
Actual Performance (Comments, Examples): / Met Standard
Needs Improvement
Service Orientation – Provides professional and timely service to internal and external customers; monitors customer satisfaction and changing needs; demonstrates dependability; takes time to listen; develops rapport in relationships; and goes the extra mile to make a difference.
Actual Performance (Comments, Examples): / Met Standard
Needs Improvement
Performance Orientation – Produces results while working toward a standard of excellence.
Needs Improvement / Met Standard
1. Meets essential functions of job description. (Refer to job description or list of essential functions.)
2. Able to prioritize and complete tasks in a timely manner (meets deadlines).
3. Maintains regular and predictable attendance.
4. Demonstrates acceptable work habits.
5. Complies with established policies and procedures.
Actual Performance (Comments, Examples):
PART II - Work Objectives/Results for This Review Period: The supervisor should complete this section with input from the employee as appropriate.
Work Objectives are work activities that support the division, department or work unit goals. List work objectives/results previously established. Provide comments regarding performance. Base results on "Did Not Meet" or "Met" Objective. (STAR = Specific, Time-bound, Attainable, Relevant)
1. / Met Objective
Comments:
Did Not Meet Objective
2. / Met Objective
Comments:
Did Not Meet Objective
PART III - Development Goals for This Review Period: The supervisor and employee should complete this section together.
Development Goals are individual goals that develop an individual’s skills, knowledge and abilities. List the specific development goals established last review period. Provide comments about the individual's performance to determine if the goals were “Met” or “Not Met.”
1. / Met Goal
Comments:
Goal Not Met
2. / Met Goal
Comments:
Goal Not Met
PART IV – Overall Assessment
Supervisor's Comments:
Employee's Comments:
PART V – Work Objectives and Development Goals for Next Review Period: The supervisor should establish work objectives with input from the employee as appropriate. The supervisor and employee should establish development goals together.
Work Objectives – Relevant and attainable work activities that support the goals of the work unit.
Development Goals – Activities that develop an individual’s skills, knowledge and abilities. Identify the specific results that the employee is expected to attain and how results will be measured.
PART VI – Signatures.
Employee (Signature only denotes that the employee has discussed this evaluation with his/her manager and does not imply that he/she agrees with the content.) / Date:
Supervisor / Leader / Date:
Next Level Supervisor / Leader / Date:
Revised November 2012