Employee Name: Review Period:
Prior to your scheduled evaluation, please complete this self-assessment. This will help prepare you and provide insight to your
manager. If you have any questions, see your manager or Human Resources.
1. List the objectives from your last review for which you were responsible and comment on how well you have
succeeded in accomplishing them. Include any additional objectives set for you that were not contained in your last
2. Since your last review, what difficulties were encountered in accomplishing your objectives, such as unplanned
changes in priorities, etc. List actions taken to resolve these:
3. State the areas of your performance that you believe could use some improvement and what could your managers do
to assist you in improving your job effectiveness?