STATE OF NEW YORK
Professional, Scientific, and Technical Services Unit
PERFORMANCE EVALUATION PROGRAM
PART I: PERFORMANCE PROGRAM
(See instructions on reverse side)
Agency
SECTION 1 – EMPLOYEE IDENTIFICATION
Employee’s Name Division/Facility
Social Security Number Section
Title Salary Grade Item Number
Supervisor/Rater Rater Title
Reviewer Reviewer Title
Evaluation Period From To
(mo/day/yr) (mo/day/yr)
SECTION 2 – PERFORMANCE PROGRAM.
A. TASKS/OBJECTIVES: List the major tasks, assignments, activities, and
results to be achieved during the evaluation period.
B. PERFORMANCE STANDARDS: List observable criteria for determining if
objectives/tasks are fully met/performed. Criteria should be quantitative
whenever possible.
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
Approved by Date
(Reviewer) (Signature)
SECTION 3 – Certification
We have met to discuss the objectives, tasks, assignments and activities indicated above. This performance program is the basis upon which job performance
will be appraised and rated on the annual rating date. The employee has had an opportunity to submit proposed tasks and standards for consideration in the
performance program.
Supervisor
(Signature) (Date)
Employee
(Signature) (Date)
I have attached written comments concerning the performance program (Optional on the part of the employee).
SECTION 4 – SIX-MONTH RECERTIFICATION
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 attached). If a rating were assigned today based upon service to
date, I would propose that it be (check one)
Satisfactory Unsatisfactory (This is not a rating; therefore, it is not appealable.)
Supervisor
(Signature) (Date)
Employee
(Signature) (Date)
(4/94)
Reprinted 7/97
INSTRUCTIONS TO SUPERVISOR
A. At the start of the process:
1. Before beginning of the rating period, discuss prospective performance requirements with the employee, and seek the
employee's input to the performance program by providing him/her with a "worksheet" and a reasonable deadline for its
return to you. (Submission of a worksheet is optional on the part of the employee.)
2. Upon receipt of the employee's worksheet (or after the deadline for its return has passed), complete Section 1 – Employee
Identification and Section 2 - Performance Program.
3. Submit performance program to reviewer (with employee’s worksheet, if any) for approval.
4. Following approval by reviewer, notify the employee of a time for discussion of the performance program. This must occur
within six weeks of the beginning of the rating period. At the appointed time, discuss performance program with employee, and
complete Section 3 - Certification. Give copy to employee, retain a copy and submit original to Personnel Office.
5. If the employee wishes to attach additional written comments concerning the performance program, he/she may do so. This
is also optional on the part of the employee.
B. At the approximate midpoint of the rating period:
1. Notify the employee of the date, time, and place for the six-month conference. (This conference should take place within
one month before or after the midpoint of the rating period.)
2. At that time, meet with the employee and discuss his/her performance to date. Discuss the employee's progress in meeting
performance standards, any accomplishments or deficiencies, and any training, development, and/or performance
improvement activities which might assist the employee in meeting tasks/objectives. Advise the employee of the rating you
would propose, if one were due at this time. If performance is less than "Satisfactory," advise the employee what he/she
must do in the time remaining in order to achieve a final rating of "Satisfactory." Employee and supervisor must sign
Section 4 - Recertification.
Note: If there are any revisions to the performance program which need to be made at this point, first obtain the approval of the
reviewer, as you did at the start of the rating period. Then meet with the employee to discuss the revisions, provide the
employee with a copy and retain a copy for yourself, and send the original to your Personnel Office. (Revised programs
must show the reviewer approval by means of a signature and date.)
Revisions can be made at any time during the evaluation period, as long as this process is followed. However, there must be a
reasonable amount of time remaining in the evaluation period for the employee to perform any new tasks or meet any new
objectives.
Reprinted 7/97
STATE OF NEW YORK
Professional, Scientific, and Technical Services Unit
PERFORMANCE EVALUATION PROGRAM
PART II: PERFORMANCE APPRAISAL AND RATING
(See instructions on reverse side)
Agency
SECTION 1 – EMPLOYEE IDENTIFICATION
Employee’s Name Division/Facility
Social Security Number Section
Title Salary Grade Item Number
Supervisor/Rater Rater Title
Reviewer Reviewer Title
Evaluation Period From To
(mo/day/yr) (mo/day/yr)
SECTION 2 – SUMMARY OF ACTUAL PERFORMANCE. Describe the employee’s performance in accomplishing tasks or achieving objectives specified in
Part I, Section 2A. Explain how the employee’s performance has either exceeded or not met the performance standards. Be as specific and quantitative as
possible.
1.
2.
3.
4.
5.
6.
7.
(Attach additional sheets if necessary)
SECTION 3 – RECOMMENDED TRAINING, DEVELOPMENT AND PERFORMANCE IMPROVEMENT ACTIVITIES
Note that in many instances, the implementation of recommended performance improvement activities may result in the assignment of more complex
Tasks/objectives appropriate to the employee’s title. If so, the performance program should reflect these revised assignments.
(4/94)
Reprinted 7/97
SECTION 4 – PERFORMANCE RATING
Check the rating which best summarized the employee’s performance, as described in Section 2. Refer to descriptions of ratings below.
SATISFACTORY UNSATISFACTORY
SUPERVISOR SIGNATURE DATE
REVIEWER SIGNATURE DATE
SECTION 5 - CERTIFICATION
I MET WITH MY SUPERVISOR ON TO DISCUSS MY JOB PERFORMANCE. I HAVE HAD AN OPPORTUNITY TO READ THIS
REPORT AND DISCUSS IT WITH MY SUPERVISOR. MY SIGNATURE DOES NOT NECESSARILY SIGNIFY AGREEMENT.
EMPLOYEE SIGNATURE DATE
CHECK IF EMPLOYEE COMMENTS ARE ATTACHED.
NOTE: If the rating is Unsatisfactory and you wish to appeal, you have 15 calendar days from receipt of the rating to submit an appeal. Contact your Personnel
Office for specific procedures.
INSTRUCTIONS TO SUPERVISOR
1. Near the end of the evaluation period, return worksheet to employee for completion of Part II: Employee Worksheet for Performance Appraisal and
Rating. Give employee a reasonable deadline for its return to you. Completion of the worksheet is optional on the part of the employee. (At this time,
you may wish to give the employee a new Part I: Employee Worksheet for Performance Program for the next rating period, as well, a deadline for its
completion. This will ensure that the employee will have the opportunity for input into the new program, as well as insure that you have adequate time
to prepare the new program and give it to the employee in a timely manner.
2. Upon receipt of the employee's worksheet - Part II, (or after the deadline for its return has passed) complete Sections 1, 2, and 3, and submit to
reviewer with a recommended final rating. (Include employee's worksheet, Part II, if any.) Discuss evaluation and recommended rating with reviewer.
3. When reviewer approves final rating, supervisor and reviewer complete Section 4. (Rating is final only upon reviewers’ approval.)
4. Following approval by reviewer, establish a time for the appraisal interview. At this time, discuss performance evaluation with employee.
5. Have employee sign and date acknowledgment in Section 5. Give copy of evaluation to employee, retain a copy, and send original to Personnel
Office.
6. If employee wishes to attach written comments concerning the evaluation, he/she may do so. This is optional on the part of the employee.
NOTE: In completing Section 3 - Recommended Training, Development, and Performance Improvement Activities, consideration should be given, if
appropriate, to such activities as in-service training, part-time study, task force assignments, PUBLIC SERVICE TRAINING PROGRAM courses,
assigned readings, career counseling, and participation in professional associations.
_______________________________________________________________________________________________________________________________
SATISFACTORY: This is a broad category which covers a wide range of employees, all of whom 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 and
competent manner. This is the level which 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 which
should be improved. The employee may meet 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 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 or effective fashion. There is a need for immediate and significant improvement in performance.
Appeal Rights:
Only ratings of Unsatisfactory are appealable. Disputes concerning such issues as an employee's performance program, and the rating
appeals process are not subject to appeal. Employees must file an appeal within 15 calendar days of the receipt of an UNSATISFACTORY rating. Appeal
forms and procedural information are available from your personnel office. Employees have the right to a personal appearance and to PEF-designated
representation before the Appeals Board.
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