PERFORMANCE APPRAISAL OF COMMUNITY HEALTH OFFICER
ANNEXURE-A
OBJECTIVES:
1To evaluate the performance of the Health & Wellness Centre Member (CHO) Member by the Reporting
Officer (herein after called as Appraiser) and appraise by the Chief District Health officer (CDHO) on the basis
of target achieved and to plan for better performance in future.
The system of appraisal is designed to facilitate an open system of review of the Assesses. Please follow the
same for the following exercise.
2. To identify the gap between the skill levels possessed by the Health & Wellness Centre Cell District Member
and the job responsibilities being performed by him. This gap can be filled by planned training activities.
3. The Self-Appraisal format gives an opportunity to the Health & Wellness Centre Cell (CHO) Member (called
as appraise) to highlight his achievements and will be rated by the appraiser and reviewed by Member Secretary
(DHS-NHM). The overall assessment of the State Programme Management Unit Member has to be made by the
Appraiser (Reporting Officer of appraise) and finalized by the Mission Director (DHM).
GUIDELINES FOR THE APPRAISER:
1. Rate your Health & Wellness Centre Member in the present position. The judgments are to be based on
the performance for the entire Review Period and not on isolated events.
2. Judgments should be objective solely based on performance. Avoid introducing personal prejudice as far
as possible.
3. Guard against the tendency to over-rate or under-rate.
Score on 1 to 10 Scale
a) 0-3.5 scale – Not recommended for Next Contract.
b) 3.6- 10 scale – Consideration for New contact with additional 5% Raise in remuneration.
PERFORMANCE APPRAISAL FORM FOR COMMUNITY HEALTH OFFICER (CHO
Review Period: ………………………. Name of Office:
Address of Office:
(GENERAL INFORMATION)
To be completed by the Assesse
Name of Assesse
Designation
Date of Birth
Date of Joining of Current contract
Contract Completion Date
Current Salary Drawn
Total leave taken during the
year.(Availed/Sanctioned)
PART-I
(SELF-APPRAISAL BY THE APPRAISE)
1. Major responsibilities assigned to you during the review period: (Not more than 100 words)
2. Performance & Achievements
A) Quantitative (for the contract period)
Sr
Assessment Indicator Achievement
No
1 Number of Community meeting conducted during month
2 Number of OPD during month
3 Number of Cases referred from HWCs (PHC/CHC)
4 Number of ANC registered against estimated
5 Number of High – risk pregnancy identify and recived folow up care
6 Number of HBNC visit /live Births
7 Number of Suspected cases identified for NCD
8 Number of OPD cases with age more than 60 years.
9 Number of Yoga Sesssion conducted
10 Number of TB patients new diangosed and received treatment
11 Number Mamta Divas/ Mamta Taruni Divas monitored.
12 Number of VHSNCs meeting held
13 Timely submission of different data Reports.
14 Support to Reporting officer for smoothly implementation of Programme.
15 Cordination with Sub centre staff.
B) Qualitative (for the contract period)
1. Submission of month wise c
2. Any extraordinary achievement made during the Contract period:
3. Shortfall in performance if any and reasons thereof:
4. Any Training Taken during the Contract period:
5. Training/Support required, if any with proper justification
6. Tried to bring political pressure or other influence especially for serviceable affairs transfer and
appointment Issues? If Yes so Give Details :
Signature of Appraise:
Designation of Appraise:
PART II
PERFORMANCE APPRAISAL BY THE REPORTING AUTHORITY
1. Period of Contract: _____________to _____________
2. Duration within which the appraise was there, out of the above period: ___________________to
______________________
3. Do you agree with the self- assessment of his performance done by the Appraise ? if not give reasons why
you do not agree.
4. Achievements by appraise apart from assigned responsibilities that has contributed by adding value to the
Project/Task assigned.
5. Detail of reprehendmand or disciplinary action, if any, during the contract period.
6. Has He/She tried to bring political pressure or other influence especially for serviceable affairs transfer and
appointment Issues? If Yes so Give Details :
ASSESSMENT OF COMPETENCE
Score competence of the candidate as per given above information and in terms of the current role requirements of the
Assesse.
Score on based on criteria given as below
S. Total Score for Appraisal by Assessor
Attributes
N. each criteria Score
1 Appropriate (0-1 mark)
a) Technical knowledge (0.5)
b) Programme knowledge (0.5)
As required to enhance the program outcome.
2 a) Time management, (0.5) (0-1.5 marks)
b) Monitoring And Evaluation skills (0.5)
3 Proper coordination skills to achieve desired outcomes with (0-1 mark)
intersectoral coordination; Intra Region, Intra
District/corporation and to Govt of India (1)
4 Documentation of best and routine practices including (0-1 mark)
Communication skills & IT Skills (1)
5 Intra- and inter-team working (0-1 mark)
(Interest taken in developing team through empowerment and
delegation) (1)
6 Ability to complete Meeting deadlines/commitments as per (0-1 mark)
supervisors request and program needs. (1)
7 Problem-solving and decision making ability which helps (0-0.5 mark)
program improvement and new initiative in direction to achieve
desired health goals. (0.5)
8 Ability to work under pressure with showing excellence of work (0-1 mark)
beyond comfort environment
9 a) Filed Visits Undertaken regularly and performing as per (0-1 mark)
requirements of program needs. (0.5)
b) Monitoring of the National Health Programs and providing
feedback to & fro with appropriate solutions. (0.5)
10 Integrity and Honesty (1) (0-1 mark)
( keeping in mind both his/her financial integrity and his/her moral integrity)
Total Marks with completion of all criteria (0-10 marks)
SECTION II: FEEDBACK FORM (By Reporting officer)
1. Overall assessment of the appraise (Score competence or knowledge/skills in terms of the current role
requirements of the Assesses. Score on 1 to 10 scale
(0 – 3.5 for poor, 3.6- 10 good 6.6 – 8.5 Very good and 8.6- 10 for Out- standing.)
Overall grade (On a score of 1-10)
Signature and Stamp of Reporting Officer
PART III
REMARKS OF THE REVIEWING AUTHORITY (CDHO)
1. Do you agree with the assessment of the Reporting officer? If not please give your remarks
on the appraise.
2. Do you agree with the assessment of the Reporting Officer about Integrity of appraise? If
not please give your remarks.
3. Has He/She tried to bring political pressure or other influence especially for serviceable
affairs transfer and appointment Issues? If Yes please give your remarks on that :
4. Overall assessment of the appraise (Score competence or knowledge/skills in terms of the
current role requirements of the Assesses. Score on 1 to 10 scale.)
(0 – 3.5 for poor, 3.6- 6.5 for good 6.6 – 8.5 Very good and 8.6- 10 for Out- standing.)
Overall grade (On a score of 1-10)
Signature:
Name:
Designation:
Date:
Health and Family welfare Department,
Govt. of Gujarat
