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Performance Feedback Non Supervisory Non Management

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Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 1 of 9
CITY OF LITTLE ROCK
PERFORMANCE FEEDBACK PROCESS
NON-SUPERVISOR / NON-MANAGEMENT POSITIONS
The Performance Feedback Process packet includes two (2) documents:
• Planning Session Worksheet (PSW),
• Performance Feedback Form
NOTE: These documents may be completed electronically or manually.
During a planning session prior to, or near the beginning of, the evaluation period,
the supervisor shall:
• Complete the Planning Session Worksheet,
• Discuss the completed worksheet with the employee to develop mutual
understanding of the performance factors and examples of performance
goals and priority work related to the factors,
• Obtain the required worksheet signatures,
• Provide a signed copy of the completed worksheet to the employee, and
• Maintain the original PSW for review during the year and for use during the
end of rating period evaluation.
Near the end of the annual review period, the supervisor shall complete the
Performance Feedback Form utilizing, but not limited to, the completed Planning
Session Worksheet (see instructions on the performance feedback form).
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 2 of 9
PERFORMANCE FEEDBACK
PLANNING SESSION WORKSHEET
NON-SUPERVISOR / NON-MANAGEMENT POSITIONS
EMPLOYEE NAME:__________________________________ EMPLOYEE ID: __________________
EMPLOYEE POSITION / DEPARTMENT: _______________________________ / _______________
SUPERVISOR: ________________________________________________________________________
EVALUATION PERIOD: ___________________________ TO ___________________________
DATE: ___________________________
Please complete this worksheet during the planning session near the beginning of the evaluation
period. To develop mutual understanding regarding the performance factors, illustrate examples
of performance expectations and goals, and priority work related to each performance factor.
PERFORMANCE FACTOR
EXAMPLES OF RELEVANT
PERFORMANCE GOALS AND PRIORITY
WORK
1. Planning and Organizing Work –
Plans and organizes assignments to
meet established deadlines.
2. Quality of Work – Work processes
and results are accurate, efficient and
meet established standards; takes
early corrective action to avoid
problems/errors; incorporates values
and standards (internal and external)
in preparing products and in providing
service.
3. Quantity of Work – Completes
assigned volume of work within
established time constraints.
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 3 of 9
PERFORMANCE FACTOR
EXAMPLES OF RELEVANT
PERFORMANCE GOALS AND PRIORITY
WORK
4. Interpersonal Skills –Interacts
effectively with all levels of
employees and customers; shares
information willingly and on a timely
basis; actively listens to concerns of
others.
5. Flexibility/Adaptability – Adapts
and modifies behavior in accordance
with varying circumstances or
changing organizational requirements;
understands and recognizes the value
of other points of view and ways of
doing things.
6. Dependability – Adheres to work
assignment and project deadlines;
consider absences and tardiness as
well as attentiveness to work
assignments.
7. Initiative – Brings issues to the
attention of appropriate personnel as
needed; persists when marked
difficulties arise; takes action to avoid
an imminent problem; proactive
pursuit of new (and more effective)
ways of doing things.
8. Customer Satisfaction –Responds to
and satisfies the varying needs of
customers.
9. Teamwork – Fosters teamwork and
cooperation with other team members
and operating units in pursuit of the
City’s goals by proactively assisting
and involving others, sharing relevant
information, and providing
constructive feedback.
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 4 of 9
The performance factors, along with performance expectations and goals, and
examples of priority work related to each performance factor, were reviewed and a
mutual understanding of these performance management elements was achieved.
It is understood that the performance expectations and goals, and priority work
items listed in Column 2 of the Planning Session Worksheet are only examples of
factors to be observed during the evaluation period. I further understand that the
list of examples is not intended to be all-inclusive and that the final evaluation will
be based on any/all observed related work behaviors.
Employee Name / Number
Supervisor Name
Employee’s Signature
Supervisor’s Signature
Job Title
Date
Date
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 5 of 9
Employee Name: ___________________________
Employee ID: ___________________________
Date: ___________________________
Evaluation Period: from ___________________________ to ___________________________
P
P
E
E
R
R
F
F
O
O
R
R
M
M
A
A
N
N
C
C
E
E
F
F
E
E
E
E
D
D
B
B
A
A
C
C
K
K
F
F
O
O
R
R
M
M
N
N
O
O
N
N
-
-
S
S
U
U
P
P
E
E
R
R
V
V
I
I
S
S
O
O
R
R
Y
Y
/
/
N
N
O
O
N
N
-
-
M
M
A
A
N
N
A
A
G
G
E
E
M
M
E
E
N
N
T
T
P
P
O
O
S
S
I
I
T
T
I
I
O
O
N
N
S
S
The following assessment should be completed for all non-supervisor / non-management employees near the end
of the annual review period. Before completing this performance feedback form, please review the performance
expectations and goals, and examples of related priority work as reviewed during the planning session. Provide
employee development feedback by citing specific examples for each of the factors identified. Use additional paper,
if appropriate.
Based on observations during the review period, rate the employee utilizing the following scale:
4 Fully Demonstrated – Performance factor was consistently demonstrated with no
significant exceptions.
3 Usually Demonstrated – Performance factor was consistently demonstrated with only a few significant
exceptions.
2 Sometimes Demonstrated – Performance factor was frequently demonstrated but with several significant
exceptions.
1 Seldom Demonstrated – Performance factor was only occasionally demonstrated.
Not Applicable – Performance factor not applicable to employee’s job.
Remember! The purpose of your narrative comments is to describe behavior and results, not evaluate it using words
such as good, excellent, or poor. This can best be achieved by means of specific, quantifiable examples. Put an “X”
at the point on the scale which you believe best represents the employee’s overall performance on that particular
item. Mark “not applicable” if it is determined that the performance factor does not apply to the duties of the subject
employee (Remember to reduce the number of factors when calculating the summary rating, if a factor is omitted).
1. Planning and Organizing Work – Plans and organizes assignments to meet established deadlines.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 6 of 9
2. Quality of Work – Work processes and results are accurate, efficient and meet established standards; takes early
corrective action to avoid problems/errors; incorporates values and standards (internal and external) in preparing
products and in providing service.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
3. Quantity of Work – Completes assigned volume of work within established time constraints.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
4. Interpersonal Skills –Interacts effectively with all levels of employees and customers; shares information
willingly and on a timely basis; actively listens to concerns of others
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 7 of 9
5. Flexibility/Adaptability – Adapts and modifies behavior in accordance with varying circumstances or changing
organizational requirements; understands and recognizes the value of other points of view and ways of doing
things.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
6. Dependability – Adheres to work assignment and project deadlines; consider absences and tardiness as well as
attentiveness to work assignments.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
7. Initiative – Brings issues to the attention of appropriate personnel as needed; persists when marked difficulties
arise; takes action to avoid an imminent problem; proactive pursuit of new (and more effective) ways of doing
things.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 8 of 9
8. Customer Satisfaction –Responds to and satisfies the varying needs of customers.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
9. Teamwork – Fosters teamwork and cooperation with other team members and operating units in pursuit of the
City’s goals by proactively assisting and involving others, sharing relevant information, and providing
constructive feedback.
FACTOR FEEDBACK
N/A
1 - Seldom
2- Sometimes
3- Usually
4- Fully
Points
Examples of Work Performance:
Developmental Needs:
Performance Feedback Planning Worksheet
Non Supervisory/ Non-Management Positions
Revised August 2018 Page 9 of 9
SUMMARY FEEDBACK
The employee’s summary rating should be based on as much fact and first-hand observation
of performance as possible. Inflating a rating for the purpose of avoiding negative feedback or
achieving a potentially higher reward for the employee is neither desirable nor acceptable.
The summary rating is the average rating of the applicable factors listed above
(e.g., TOTAL POINTS / NUMBER OF APPLICABLE FACTORS)
Seldom
1
Sometimes
2
Usually
3
Fully
4
Total
Points
1 1.5 2 2.5 3 3.5 4
I have read this appraisal and have discussed the results with my manager. My signature does
not imply agreement, only that the discussion took place and feedback was provided.
Employee’s Signature
Date
Immediate Supervisor’s Signature
Date
Department Director’s Signature
Date
Employee Comments:
Supervisor Comments:
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Completed 21 March 2020

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