State of Connecticut Human Resources
Employee Service Rating
Maintenance & Service (NP-2) Unit
Form # PER-148
Revision Date: 12/2003
DATE
TYPE OF PERFORMANCE APPRAISAL DATE OF LAST REVIEW
INITIAL PROBATIONAR
Y
ANNUAL PROMOTIONAL OTHER
EMPLOYEE NAME EMPLOYEE
NUMBER
TITLE PERIOD COVERED
DIVISION DEPARTMENT
INSTRUCTIONS:
DEFINITIONS:
Evaluate the employee on the job (position) being performed during the period noted above. Check the box
which represents your objective evaluation of each job element.
EXCELLENT - Exceeds Standards Consistently
GOOD - Meets All Expectations, High Achiever, Strives Towards Excellence
SATISFACTORY - Meets Minimum Required Standards of Acceptance
FAIR - Requires improvement, Yet is Passable
UNSATISFACTORY - Below Acceptable Standards
JOB ELEMENTS EXCELLENT GOOD SATISFACTORY FAIR UNSATISFACTORY
KNOWLEDGE OF
WORK: (Job Related)
What individual knows
through education,
experience and special
training.
QUANTITY OF WORK:
Volume of work produced.
QUALITY OF WORK:
Neatness, accuracy,
frequency of errors.
ATTENDANCE:
Tardiness, absenteeism, use
of sick leave.
COOPERATIVENESS:
Acceptance of authority,
directives, work
relationships with fellow
employees, accepting
responsibility.
COMMENTS: (Provide brief explanation of reasons for any category rating of Fair or Unsatisfactory. Relative
supportive comments for ratings are permissible. [Reference Article 9, Section Five of the
Contract])
This form provided by the Department of Administrative Services
This form provided by the Department of Administrative Services
OVERALL RATING: A rating of “Unsatisfactory” in one (1) category or of “Fair” in two (2) categories shall constitute a
rating of “Less Than Good”.
Check Appropriate Box
EXCELLENT GOOD SATISFACTORY FAIR UNSATISFACTORY
RATED BY:
DATE:
REVIEWED BY:
DATE:
APPROVED BY:
DATE:
EMPLOYEE:
DATE:
NOTE TO EMPLOYEE: Your signature confirms that you have seen this report and discussed it with your supervisor.
It does not indicate your agreement with or approval of the rating. [Reference: Article 9,
Section Two of the Contract].
NOTE TO SUPERVISOR: Ensure that the employee receives a copy of this service rating at the time of signing.