Performance Evaluation Program
Administrative, Operational, Institutional Services Units, and
Division of Military and Naval Affairs Unit
ANNUAL
PERFORMANCE
EVALUATION FORM
__________________________________________________________________________________________
INSTRUCTIONS TO SUPERVISORS
AT THE START OF THE AT THE MIDPOINT OF THE AT THE END OF THE
EVALUATION PERIOD EVALUATION PERIOD EVALUATION PERIOD
Complete Sections 1 and 2A. Complete Section 3. (Optional) Complete Sections 2B, 4, 5, and 6___
SECTION 1 - EMPLOYEE IDENTIFICATION
Enter the following information.
Employees’ Name:
Agency:
Social Security Number:
Department:
Title:
Salary Grade:
Item Number:
Evaluation Period: From:
To:
Employee’s Negotiating Unit:
Administrative Services Institutional Services Operational Services
SECTION 2A - PERFORMANCE PROGRAM SECTION 2B - PERFORMANCE APPRAISAL
List the important tasks of the job and briefly describe how you expect
each to be performed. Your expectations should be expressed in terms of
quality and/or quantity where possible.
Describe the employee’s performance in accomplishing the tasks specified
in Section 2A. Explain how the employee’s performance met, exceeded or
failed to meet your expectations.
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
I received a copy of this performance program on: Employee:
(Date) (Initials)
(Attach additional sheets, if necessary)
______________________________________________________________________________________________________________________
SECTION 3 - SIX-MONTH RECERTIFICATION (OPTIONAL)
We met within one month before or after the approximate midpoint of the rating period to discuss the employee’s performance, and to reaffirm or revise the
performance program (If revised, changes have been reviewed and approved, and revisions are attached). If a rating were assigned today based upon service to date, I
would propose that it be
Satisfactory Unsatisfactory (check one). This is not a rating; therefore, it is not appealable.
Supervisor: _____________________________________________________ _________________________________________________
(Signature) (Date)
Employee: _____________________________________________________ _________________________________________________
(Signature) (Date)
---XXX-XX-XXXX---
SECTION 4 - SUPERVISOR’S COMMENTS
Comment on other aspects of the employee’s performance (such as skills, behaviors, personal characteristics and the time and attendance
patterns) which have affected the employee’s performance or the performance of other employees. Suggest ways in which performance can
be improved.
Prepared by:
Signature Date
_________________________________________________________________________________________________________________________
SECTION 5 - PERFORMANCE RATING
Check the rating which best summarizes the employee’s performance. A rating of “Unsatisfactory” must be supported by specific
explanation and justification.
Satisfactory: This is a broad category which covers a wide range of employees, all of who are performing
acceptably. It is the expected and usual level of performance. The employee generally meets performance
expectations as specified in the performance program for all tasks and performs in a good, competent
manner. This is the level that can minimally be expected from an employee in order for the work unit to
function effectively.
The employee’s performance may also be characterized as meeting minimal performance expectations for the
job yet there may be areas of performance that should be improved. The employee may meet performance
expectations for certain tasks or assignments, but some assignments may require extra follow-up and
direction by the supervisor. It is only when the employee’s performance clearly shows that it is below
the expected performance level that a rating other than “Satisfactory” should be considered.
Note: Because this rating covers a wide range of performance, supervisors may want to consider the length
of time the employee has been in the job as appropriate (i.e., employees in the same job title may be
performing satisfactorily but at different levels due to length of time and/or experience on the job).
Unsatisfactory: The employee clearly does not meet performance expectations for one or more tasks, not
even at a minimally acceptable level. The employee requires significant extra direction, or the
supervisor finds it necessary to avoid assigning normal tasks to the employee. The employee cannot be
relied upon to carry out critical assignments in a timely and effective fashion. There is a need for
immediate and significant improvement in performance.
Appeal Rights: Only ratings of UNSATISFACTORY are
appealable. Disputes concerning issues such as an employee’s performance program, and the rating and
appeals process are not subject to appeal. Employees must file an appeal within
15 calendar days of the
receipt of an UNSATISFACTORY rating. Appeals forms and procedural information are available from your
personnel office. Employees have the right to a personal appearance and to CSEA-designated representation
before the Appeals Board.
________________________________________________________________________________________________________________
SECTION 6 - REVIEW AND APPROVAL
The employee’s rating is not final until it is reviewed and approved.
Approved by:
Signature Date
_________________________________________________________________________________________________________________________
SECTION 7 - EMPLOYEE COMMENTS
I met with my supervisor on
to discuss my work performance. I have read this evaluation and
discussed it with my supervisor. My signature does not necessarily signify that I agree with my evaluation.
My written comments concerning this evaluation follow (optional):
__________________________________________________________ (Attach additional sheets if necessary)
(Signature) (Date)
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