MEDICAL LABORATORY

Performance Appraisal Instructions for

Medical Laboratory technologist and Assistant Medical Laboratory technician

General Instructions

This performance appraisal is designed for supervisors to assess the performance of their employees.
Section I allows for “job-specific” evaluation. Section II provides for a series of key performance
indicators related to the job. Section III identifies training and future goals. The rating scale below
should be used in each section. Upon completion of the appraisal, the supervisor should sign the
document and obtain the necessary signatures of the reviewer and the employee.

   

This Performance Appraisal Form is to be used for all personnel in the grade of medical laboratory
technologist and assistant medical laboratory technician

Explanation of Rating Levels

Rating

Excels Performance which is consistently better than that expected of a fully

proficient employee.

Proficient Performance which meets the expectations of an employee for this job
classification.

Needs Improvement Performance less than that of a fully proficient employee; improvement
necessary.

Unsatisfactory Performance that does not meet minimum job requirements; immediate
and substantial improvement is necessary.

Section I
Directions:

Classified Staff Employee: This section of the form is designed to make the form “job specific”
by listing, in order of importance, the major responsibilities of the job being evaluated. Rate the
employee’s performance on each essential function of the job using the rating scale described on
the instruction sheet.

Managerial/Professional Employee: In units where goals and objectives have been identified
in writing, the employee should be evaluated on those pre-determined and pre-defined goals or
objectives. In units where goals and objectives have not been established, the supervisor should
identify the major duties and/or responsibilities of the job and evaluate the employee
accordingly. In either situation, a performance dimension for all supervisory personnel is a
commitment to equal employment opportunity and diversity in the workplace. In cases where
pre-determined goals and objectives are not used, the employee should be evaluated on projects,
job duties, and special assignments. Check the appropriate performance level.

Rating Scale
(Check One)

Unsatisfactory
Improvement
Proficient
Excels

Others
Needs
Description of major responsibilities:

1) Goal/Objective/Project/Major Job Duty/Special Assignment

JOB KNOWLEDGE

2) Goal/Objective/Project/Major Job Duty/Special Assignment

MANAGEMENT SKILLS

3) Goal/Objective/Project/Major Job Duty/Special Assignment

CUSTOMER FOCUS

4) Goal/Objective/Project/Major Job Duty/Special Assignment

ETHICAL CONDUCT & INTERPERSONAL RELATIONSHIPS

5) Goal/Objective/Project/Major Job Duty/Special Assignment

LEADERSHIP SKILLS & TEAMWORK

If other major responsibilities have been identified that have not been captured in any of the 5 responsibilities
listed above please attach an additional sheet rating those responsibilities.
Identify any training or development activities the employee has completed since his/her last performance appraisal.

a)

b)

c)
 Section II

Directions: In this section, the work factors tend to reinforce the performance levels identified in Section I. Place a
check (√) in the column that best identifies the employee’s job performance and make comments as appropriate.

The supervisor’s written comments can be the most important part of this appraisal section. For any rating
other than “proficient” a comment is required.

If the employee is classified staff, please complete performance factors 1 through 11 and item 12, if applicable. If
the employee falls in the Managerial/Professional category, please complete performance factors 1 through 16.

Rating Scale
(Check One)

Unsatisfactory
Improvement
Proficient
Excels

Others
Needs
Key Performance Indicators:
1) Job Knowledge/Skills: Measures effectiveness in keeping knowledge of various
methods, techniques, and skills required in own job, and related functions; to be aware of
new methodologies in the various fields of the clinical laboratory.
To what extent does the employee maintain a satisfactory level of job knowledge
and job skills?

Comments:

2) Quality of Work: Adhering to the organizational culture; the laboratory quality

management policies and applying the skills required to implement those policies.
To what extent does the employee’s work meet the required quality standards, i.e.,
accuracy, neatness, and thoroughness?
Comments:

3) Productivity: Measures the effectiveness in establishing appropriate reporting and

control procedures in accomplishing assigned tasks.
To what extent does the employee accomplish the quantity of work expected of the
job assigned and use time and resources appropriately?
Comments:
4) Record Keeping/Documentation
To what extent does the employee adequately prepare and maintain records,
written reports, correspondence, and files?
Comments:

5) Reliability & Dependability: Measures how well an employee complies with

instructions and performs under unusual circumstances at the same time being proactive.
To what extent does the employee perform work consistently without close
supervision or assistance?
Comments:

6) Adaptability
To what extent does the employee readily adapt to new situations and changes in
routines, work load, and work assignments?
Comments:

7) Initiative
To what extent does the employee present new ideas, improve procedures or
otherwise demonstrate an awareness of clerical or technical changes related to the
job, and take appropriate action without instruction or urges?
Comments:

8) Attendance
To what extent does the employee maintain satisfactory attendance in regard to
tardiness, early departures, absences, and working assigned schedule?
Comments:

9) Relations with others

To what extent does the employee establish effective working relationships when
dealing with others (supervisors, co-workers, patients, the public, etc.) and promote
the effectiveness of other employees?
Comments:

10) Customer Service: Measures responsiveness and courtesy in dealing with internal
staff, external customers, and other stakeholders within the organizational parameters.
To what extent does the employee demonstrate excellence in customer service when
dealing with students, faculty, staff, patients, and the public?
Comments:

11) Adhere to Policies and Procedures

To what extent does the employee follow the management by objectives guidelines
and department-specific policies and procedures (i.e., safety, dress policy,
professionalism, and administrative policies and procedures)?
Comments:

12) Department Specific Performance Factor

Comments:

Managerial Categories

13) Planning and Analytical Ability: Measures effectiveness in initiating changes,

adapting to necessary changes from old methods when they are no longer practical,
identifying new methods, and generating improvement in facilitating performances.
To what extent does the employee demonstrate the skills to analyze, solve problems,
and prioritize?
Comments:

14) Managerial Skills

To what extent does the employee effectively work well with and through others to
complete assignments in a timely and productive manner demonstrating a
commitment to customer service?
Comments:

15) Mentoring of Others

a) To what extent does the employee guide/encourage others to become more
effective in work assignments and better prepared for future professional
development?
Comments:

b) To what extent does the employee effectively evaluate others, ensuring

productive work in support of the college/school/division’s strategic plan, including
the development of an Employee Development Plan or Performance Improvement
Plan when needed?
Comments:

16) Communication Skills

To what extent can the employee effectively express himself/herself orally and in
writing including correspondence, reports, and presentations at conferences,
seminars, workshops, etc., as required by the job?
Comments:
 Section III

Directions: This section will be used to identify areas in which job performance has been significantly above
average, areas where performance improvement is needed and an action plan to achieve improvement, development
and training recommendations to enhance and/or develop new skills, and goal/objectives for the upcoming year.

A. Supervisor’s Comments (Job Performance)

1. Areas in which job performance has been significantly above average:

2. Areas in which job performance can be enhanced through further development and recommended
strategies or programs for achieving such:

3. Areas in which job performance improvement is needed and reasons why improvement is needed:

Employee Action Plan

Area of Performance or Why Improvement Is Expected Performance Time Line
Conduct Requiring Needed
Improvement

B. Development and Training

 Indicate recommendations for further development and training for purposes of preparing the employee for
additional responsibilities or for the improvement of current job performance.

a)

b)

c)

C. Future Development Goals/Objectives

List goals/objectives/special projects to be accomplished by the next annual appraisal. Include the
employee’s professional development as well as departmental objectives, which have been mutually agreed
upon and which support the College’s/School’s/Division’s Strategic Plan.

a)

b)

c)
 Section IV

Directions: This section should be used for the supervisor to rate the overall performance, obtain requested
signatures, and the employee’s comments. The overall performance rating should be used in determining the
employee’s merit increase recommendation if any. The employee’s merit increase is contingent upon performance
continuing at the same level.

If an employee’s rating is below proficient, an Employee Action Plan (Section III, A.3) is required. This section can
also be used to update a past action plan.

A) Overall Performance Rating

Rating Explanation of Rating Levels

Excels Performance which is consistently better than that expected of a fully proficient
employee.

Proficient Performance which meets the expectations of an employee for this job
classification.

Needs Improvement Performance less than that of a fully proficient employee; improvement
necessary.

Unsatisfactory Performance that does not meet minimum job requirements;

immediate and substantial improvement is necessary.

Excels Proficient Needs Improvement* Unsatisfactory*

* Employee Action Plan (Section III, A.3) is required.

Signatures (Manager or Supervisor & Employee) and Employee Comments

Evaluated by Title
(Immediate Supervisor)

Reviewed by Title

TO THE EMPLOYEE
You are requested to sign on the line provided below to indicate only that you have had an opportunity to review and
discuss your performance appraisal with your supervisor.

Employee’s Signature Date

Employee’s Comments (optional):