State of Connecticut Human Resources
Employee Service Rating
Administrative and Residual (P5) Unit
Form #: PER-127
Revision Date: 3/2000
INSTRUCTIONS: Read instructions on reverse
Side carefully before completing this report.
TO: Human Resources Business Center, Dept. of Administrative Services, 165 Capitol Avenue, Hartford, CT 06106
TYPE OF SERVICE RATING
INITIAL PROBATIONARY
ANNUAL
PROMOTIONAL
OTHER (Specify)
EMPLOYEE NAME CLASS TITLE
DEPARTMENT OR INSTITUTION PERIOD
COVERED
FROM TO AI DATE
FACTORS
Good or
Better
Less Than
Good
DEFINITION OF RATINGS
Evaluate the employee on the job now
being performed based on the report
period. Check (x) the rating category
which most nearly describes your overall
judgment for each of the job factors
E
X
C
E
L
L
E
N
T
S
U
P
E
R
I
O
R
S
A
T
I
S
F
A
C
T
O
R
Y
F
A
I
R
U
N
S
A
T
I
S
F
A
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T
O
R
Y
EXCELLENT = Distinctly and consistently outstanding.
SUPERIOR = Definitely above the norm.
SATISFACTORY = Meets basic requirements
FAIR = Need for improvement.
UNSATISFACTORY = Definitely inadequate.
NOTE: Written explanations are required for ratings of “Less than Good”,
and they are recommended for ratings of “Excellent”.
QUALITY OF WORK:
Thoroughness, accuracy and appearance
of work, regardless of volume
EXPLANATION
_______________________________________________________________________________________________
SUGGESTIONS FOR IMPROVEMENT
QUANTITY OF WORK:
The amount of work produced under
normal conditions, disregarding errors,
and giving full consideration to
contributions in all official areas.
EXPLANATION
_______________________________________________________________________________________________
SUGGESTIONS FOR IMPROVEMENT
DEPENDABILITY:
The ability to do assigned tasks on
schedule under normal circumstances
with a minimum of supervision.
Unauthorized absence should be
considered as it affects dependability.
EXPLANATION
_______________________________________________________________________________________________
SUGGESTIONS FOR IMPROVEMENT
ABILITY TO DEAL WITH PEOPLE:
Relationships with staff and the public;
cooperativeness.
EXPLANATION
_______________________________________________________________________________________________
SUGGESTIONS FOR IMPROVEMENT
SUPERVISORY ABILITY:
(if applicable)
The ability to delegate authority and
accomplish assigned tasks through
subordinates.
EXPLANATION
_______________________________________________________________________________________________
SUGGESTIONS FOR IMPROVEMENT
RATED BY:
SIGNATURE TITLE DATE “Less Than Good” service rating must
include a recommendation regarding
REVIEWED BY:
SIGNATURE TITLE DATE the annual increment and should result
in counseling of the employee.
APPOINTING AUTHORITY OR
AUTHORIZED
REPRESENTTIVE:
SIGNATURE TITLE DATE
Award A.I. Deny A.I.
EMPLOYEE:
SIGNATURE TITLE 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. The supervisor must give the employee a copy of the rating at the time the employee signs it.
Should any subsequent change be made, all copies must be revised, and the change must be initialed by the employee.
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GENERAL INSTRUCTIONS
I. When To File A Service Rating
A Service Rating Report is to be filed at the following times:
A. During any working test period, either promotional or original, the quality of service of any employee shall be
reported as either “Good or Better” for satisfactory or better performance and the form shall be on file in the office of
the appointing authority not more than six nor less than two weeks prior to the termination of the period; or “less than
good” performance, and the report shall be approved by the appointing authority and filed with the Commissioner of
Administrative Services; an unsatisfactory service rating of an employee serving a working test period necessitates
his/her release or demotion to a class in which he/she has prior status not later than upon termination of the working
test period.
B. When the performance of an employee with permanent status has been “Less than Good”; if the reviewer recommends
precluding the annual salary increase, the report shall be approved by the appointing authority and filed with the
Commissioner of Administrative Services prior to the employee’s increase date.
C. When the appointing authority wishes to amend a previously submitted Fair or “Less Than Good” service report due
to marked improvement in an employee’s performance, such report shall be filed with the Office of the Commissioner
of the Department of Administrative Services not later than two weeks prior to the increase date, and it shall have
precedence over previous reports and shall restore the annual increase.
D. Annually for each permanent employee, said annual rating is to be filed in the office of the appointing authority at
least three months prior to the employee’s annual increase date.
E. At such other times as the appointing authority deems that the quality of service of an employee should be recorded.
II. Preparing The Service Rating
A. For the job factor “Dependability”, in considering abuse of attendance, the rater may consider absences exceeding the
contractually earned leave days, except that he/she may also consider clearly identifiable “pattern” absences and/or
repeated or extended unauthorized leave by an employee.
B. All ratings are to be discussed with the employee by the employee’s immediate supervisor. The employee should be
asked to sign the report, indicating that the employee has seen the form and discussed it with the immediate
supervisor. The effective date of the rating shall be the date it is approved by the appointing authority.
C. A copy of a “Less than Good” service rating is to be furnished to the employee, after having been approved.
III. Consequences Of A “Less than Good” Service Rating
A. A rating of “Fair” in two or more job factors constitutes an overall “Less than Good” service rating and may
result in
the employee being precluded from receiving the next annual salary increase.
B. A rating of “Unsatisfactory” in one or more job factors constitutes an overall “Less than Good” service rating. If the
employee receives a “Less than Good” service rating while on an initial or promotional working test period, the
employee must be terminated or demoted, respectively, to a job class in which he/she held prior permanent status. If
the employee receives a “Less than Good” rating and is not on a working test period, the “Less than Good” rating may
preclude the employee from receiving an annual increase and shall
preclude the employee from participating in
Agency promotional merit system examinations. Two successive “less than good” service ratings, filed within a two
year period, may result in the dismissal of the employee from State service.
C. A review of any “Less than Good” service rating, other than those issued during any working test period, shall be done
within sixty calendar days of the date of the original to determine whether improvement has been made and an
amended service rating is in order. The effective date of any service rating shall be the date approved by the
appointing authority.
PER-127 Updated 3/00
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