CONFIDENTIAL

UNIVERSITY OF ILORIN TEACHING HOSPITAL

P.M.B .1459, ILORIN.

ANNUAL PERFORMANCE EVALUATION REPORT

PERIOD OF REPORTS FROM……………………………….. TO………………..…………

PART ONE

PERSONAL RECORDS OF EMPLOYEE

[To be completed by officers on EUSS 01 and above]

1. Name of officer………………………………………………………...…………………………………
[Surname] [Forenames]

2. Date of birth……/……/……Place of birth………….………….Nationality……..………..……….

3. Department [indicate Section/Division]………………..………………..…………………………..

4. Qualifications held [Degree, Diploma, Certificate etc with dates] underline those
acquire during period of report……...……………………………………………………….………….

…………………………………………………………………………………………………………………..

5. Date of first appointment into the service…………………….…………………………………….

Date of confirmation of appointment………………………………….……….………………………

6. Substantive grade on first appointment………………………………...…………………………..

7. Present substantive grade…………………………………………………..………………………….

8. Date appointed on substantive grade………………………………………..…………………….

9. Acting appointment held during period of report: indicate the portion (to the nearest
month) of the period spent in grade………………………...………………………………………….

10. Course undertaken during period of report: (If any….………………………………………….

………………………………………………………………………………………………………………..…
…………………………………………………………………………………………………………………..
11. Total number of days absent during period of report…………………….……………………..

…………………………………………………………………………………………………………………..

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12. Present job description:

a. State below in order of importance the main duties performed during period of report:

………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………..……………..………………………………………………………………………………
…………………………………………………………………..…………………………………………..
b. State ad hoc duties performed which are not of a continuous nature:

……………………………..………………………………………………………………………………..
………………………………………………………………………………………………………………
………..……………………………………………………………………………………………………..
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

PART TWO
.
13. To be completed by reporting officer
Do you and the person reported upon agree on the job description and the order
of importance (if not, please discuss the changes with him and record any unresolved
different here)
14. Assessment of performance:
How effective is he/she in the performance of the duties set out in 12 (a)? What is
needed here is an indication for each of the duties in 12(a) of how far he/she has
achieved the required results).
15. Aspect of performance:

In assessing performance you have already considered some or all of the following
aspects; would you now comment on and assess the aspect separately. Each aspect is
described in term of outstanding (A) and unsatisfactory performance (E). The three
intermediate ratings (B, C, D) represent behavior between these extremes.

Rating ‘A’ or’ E’ should be given if you believe it is a generally true statement that
could be supported, if necessary by specific occurrences.

If you feel an aspect of performance not in the list calls for special comment,
mention it at the end.

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 A B C D E
(a) Foresight Anticipates problems Grapples with problems
and develops solution in after they arise.
advance
(b) Penetration Get straight to the roots seldom sees below the
of a problems surface of a problem
(c) Judgement His decision or Poor perception of
proposals are relative merit or
consistently sound feasibility in most
situations.
(d) Expression on paper Always cogent, clear and ambiguous, clumsy and
well set out obscure
(e) Oral expression put his points across Find difficulties in
convincingly and expressing himself.
Concisely.
(f) Numerical ability (if Accurate in the use and Get confused with figures
applicable) interpretation of figures
(g) Relation with Sensitive to other Ignores or belittles other
colleagues peoples’ feelings. peoples feeling;
Tactful and intolerant does not earn
understanding of respect.
personal problems;
earns great respect.
(h) Relations with the Exceptionally effective Tactless and cannot deal
public in dealing with people with the public.
)
Of all types.
(i) Acceptance of seeks and accept Avoid responsibility; will
responsibility responsibility at all time pass it on when possible
(j) Reliability under performs competently Easily thrown off balance;
pressure under Not reliable even under
normal circumstances.
(k) Drive and Wholehearted Lacks determination;
Determination application to task; easily baulked by minor
Determined to carry setbacks.
task through to the end
(l) Application of Highly proficient in the Deficient in applying
professional/technical practical application of professional/ technical
knowledge (if professional/technical knowledge to practical
applicable) knowledge. issues.
(m) Management of staff(if Organises and inspired Inefficient in the use of
applicable) staff to give to their best staff; engenders low
morale
(n) Output of work Gets a great done within Sloppish in output.
a set of time frame.
(o) Quality of works Maintains very high Maintains consistently
standard; work id low standard of work,
virtually error proof source of constant
complaint.
(p) Punctuality Regularly punctual at No regard for punctuality
work

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 Indicate overall performance of duties by ticking the appropriate box below.
(The assessment should reflect performance actually achieved in the
circumstances which prevailed)

Outstanding Exceptional effective 1

Very Good More than generally effective

but not positively outstanding 2

Good Generally effective 3

Fire Perform duties moderately well and without 4

Unsatisfactory Definitely ineffective and not up to the duties 5

I certified that I have seen the contents of this report and that my superior has
discussed them with me. I have the following comment to add.

Signature of officer reported on……………………….. Grade level…………...……

Job title……………….…………………………………….. Date…………………………

PART THREE
)

16. Training needs

(In completing this section you should take account of any vies expressed by the person
reported on)

(a) If, as a result of the assessments made earlier in the report, you should consider that
performance or potential could be improved by training, please specify the needs.
(b) If they cannot be met by training on the job, please suggest, if possible, in which
way they might be met.

17. Next job at the same level

(In completing this section, you should take account of any views expressed by the
person reported on) Should be considered during the next year for:
(a) A different job in the same grade YES/NO
(b) Transfer to a job at similar level in another occupational group or cadre YES/NO*
If you have answered YES to either question, say which kind of a job and give your
reasons below:

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18. Promotability

(a) Normal promotion well fitted for promotion to 1

He is at present

or fitted 2

(Grade)

or Not fitted 3

Comment your recommendation:

(b) Special promotion (i.e. selection for training grades, grade skipping or promotion into
another occupational group or cadre)

He should be specially considered for promotion to………………………………………………

(Grade)

Give the reasons for your recommendation:

*Delete which is not applicable

19. Long term potential )

at present, he seems

Unlikely to progress further 1

or to have potential to rise about one grade but probably no further 2

or to have potential to rise two or three grades 3

or to have exceptional potential 4

20. General Remarks

Please provide any additional relevant information here, drawing attention

to any particular strengths or weaknesses.

He has served under me for the past…………..…years…………..…months………...…..

Signature…………………..……….Grade……..…………………Date……..………………....

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Name in block letters………………………………………………………………………………

PART FOUR

21. Countersigning Officer‘s Report

You should confirm that you agree with the reporting officer’s assessment, or
indicate in the foregoing sections any disagreements which may remain after
discussing them with him. You should also indicate how frequently you have the
work of the person reported on. Add any further relevant comment, including
whether any of the assessments in the report have been bought to the attention of
the person reported on.

22. General Remarks

Please provide any additional relevant information here, drawing attention
to any particular strengths or weaknesses.
He has served under me for the past………………..……….Years….…………….Months
Signature………………………..Grade………………………Date….…………………………
Name in block letters………………………………………………………………………………
)