Employee:
Job Title:
Department: ________________________________
Period of Evaluation: From:
PART I INSTRUCTION TO RATER
Listed below are five performance (on-the-job) factors, five behavioral traits, and five supervisory factors that are
important in the performance of the employee’s job. Performance factors and behavioral traits must be noted for all
employees. The supervisory factors should however only be considered for employees with supervisory
responsibilities.
The “overall performance” evaluation should reflect the employee’s total performance, including the performance
factors as related to the employee’s responsibilities and duties as set out in the job description, behavioral traits and
supervisory factors, if applicable.
Distribution Instructions: 1. Return the original form to Human Resource Dept.
2. Maintain a copy for department records.
3. Distribute one copy to the employee.
Rating Instructions: The supervisor should indicate the employee’s by ticking the appropriate level
of performance
The following rating scale has been provided to assist the rater in assigning the most appropriate measurement of the
employee’s performance factors, behavioral traits and supervisory factors.
Rating Scale Description
1 = Below Expectation Minimally/barely achieved performance expectations and set goals.
2 = Meets Expectation Achieved majority but not all performance expectation and set goals and
achieved all performance expectation in Key areas of their job function
3 = Exceed Expectation Achieved All of performance expectation and set goals and excelled in a number
of key areas of the job function
4 = Outstanding Achieved All of performance expectation and set goals and excelled in a majority
of the key areas of the job function
PART II PERFORMANCE FACTORS
Ratings Comments
1 2 3 4
Ability to deliver on task
Quality of Work
Timeliness of task completions
Amount of consistent improvement
Performance with minimal supervision
Performance Factors Total Score
PART III BEHAVIORAL FACTORS AND PERFORMANCE ATTRIBUTES
Ratings Comments
1 2 3 4
Dependability
Service Focus
Responsibility
Collaborating and communicating
Adaptability
Behavioral Factors and Performance Attributes
Total Score
PART IV SUPERVISORY FACTORS (Only for employees with supervisory responsibilities)
Ratings Comments
1 2 3 4
Leadership
Delegation
Planning & organizing
Administration
People Management
Total Supervisory Score
PART V: RECOMMENDATION GUIDE
Actual Total Score Translation Scale Recommendation
Non-Supervisory Supervisory
1-14 1-24 1 Poor Performance Terminate
15-24 25-39 2 Average/Potential for Defer Probation Period for 1 Month
Improvement
25-40 40-60 3 Meets/Exceeds Confirm
Expectation
(i) TO THE EMPLOYEE:
I have been advised of my performance ratings. I have discussed the contents of this review with my Supervisor.
My comments are as follows (attach additional sheets if necessary):
Comments
Employee’s Name: _______________________ Signature & Date: ________________________
(ii) Human Resources Comments
Name: _________________________ Signature: ___________________________ Date: ___________________________
(iii) CEO’s Comments
Name: _________________________ Signature: ___________________________ Date: ___________________________
