Fill - Free fillable U.S. Foreign Service Employee Evaluation Report for FS-02, FS-01 and Senior Foreign Service tenured employees only Instructions for Preparation Form DS-5055-I PDF form

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U.S. Department of State

FOREIGN SERVICE EMPLOYEE EVALUATION

REPORT

DS-5055 INSTRUCTIONS

INTRODUCTION

REPORT FORM

Form DS-5055 must be used for all required (i.e., regular and interim)

evaluations - for tenured and untenured FS employees, except for those of

personnel assigned to training (who use DS-7772 (outside academic

institution) or DS- 651 (language training)). (Note: If preferred, the DS-

5055 may be used instead of the DS-7768 for voluntary EERs.) Career Civil

Service employees serving on excursion limited non-career appointments

also must use this form. No narrative may exceed the space provided for it,

except in Section X where the employee may use continuation sheets, and

Section IV where the review panel may also use continuation sheets. EERs

may not be classified or contain classified information.

REPORT SUBMISSION

The post or bureau human resources office will submit the completed EER to

the eOPF in ePerformance. EERs must be submitted within 30 days of the

end of the rating period. Any delay over 30 days in submission of an EER

must be notified to HR/PE. Note: Exceptions to the use of ePerformance are

limited, and the bureau/post HRO must request the exception in advance by

contacting HR-PEQuestions@state.gov.

RATING PERIOD AND REPORT TYPES

There are three types of rating periods and report types.

A. Regular: The annual rating cycle is from April 16 of one year to April 15

of the next year for all tenured Foreign Service employees and untenured

specialists. For untenured generalists, the annual rating cycle begins on the

date of arrival in the assignment.

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B. Interim: If a change of rater, assignment, or major duties occurs during

the regular rating period, an interim report must be prepared for periods of

120 days or more, including for untenured generalists.

C. Voluntary: Raters should prepare voluntary reports for periods of fewer

than 120 days only when required to document significant developments

pertaining to the employee's performance that cannot be adequately

documented in the next regular evaluation. Voluntary reports are not to be

used to document performance during a detail or temporary duty

assignment when the employee will return to his or her regular position and

be evaluated for the full period.

DEFINITION OF RATER AND REVIEWER

The employee must be advised in writing at the beginning of the rating

period who the rater will be. The rater is usually the employee’s official

supervisor. (See 3 FAH-1 2813.3 regarding regional personnel.) The

reviewer is usually the rater’s supervisor or the next highest- ranking official.

Every effort should be made to ensure that employees have a reviewer. If

this is not possible, the employee should be informed in writing at the

beginning of the rating period that there will be no reviewer.

ENSURING FAIRNESS: Rated employees must be given the opportunity to

perform their assigned duties and must be evaluated on their performance

of the established work requirements. Although the DS 5055 no longer

requires a Work Requirements Statement, rated employees, raters and

reviewers must establish a detailed Work Requirements Statement within

the first 45 days of the rating period and a signed copy should be kept by

the rated employee, rater and reviewer. This information will form the basis

for the work responsibilities included on the DS 5055. A rater must discuss

the work responsibilities and what constitutes acceptable performance with

the rated employee at the beginning of the rating period and provide

feedback on the employee's performance during this period. In situations

where employees are not performing at an acceptable level, they must be

counseled and afforded a reasonable period of time to improve.

PREPARATION INSTRUCTIONS

SECTION I. SUBMISSION CONTROL

This section contains general employee information (name, position title,

grade, series, and post or organization) populated from the employee’s

record in the Global Employment Management System (GEMS). Type of

Report and Period Covered are completed by the rater. The rater and

reviewer signatures will automatically populate when each certify the report

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is complete, in conformance with the instructions, and adequately

documents performance. Date received in Post/Bureau and Date Received in

HR/PE will populate when the employee acknowledges receipt of the EER and

when the review panel chairperson certifies the EER is complete,

respectively.

SECTION II. CERTIFICATION OF WORK

RESPONSIBILITIES AND PERFORMANCE REVIEW

DISCUSSIONS

The rater, reviewer, and rated employee must formalize the employee’s

work responsibilities within 45 days of the beginning of the rating period.

Completion of Section V in ePerformance will automatically populate the

respective date block in Section II. The core work responsibilities and goals

and objectives requirements may be revised during the rating period to

reflect a major change in the employee's responsibilities as documented in

the separate Work Requirements Statement (which is no longer part of the

EER).

This section also certifies that the rater reviewed the performance with the

rated employee at least twice, at regular intervals, during a rating period,

with at least one discussion recorded on Form DS- 1974, preferably in

ePerformance. Raters should use these sessions to ensure that the

employee is apprised of how well he or she is progressing in achieving the

work responsibilities. Discussions between the rater and the rated employee

should address specific areas of accomplishment and/or areas in which the

rated employee should improve. Assessments included in the final EER

should not surprise the rated employee. If the rated employee believes that

the dates of performance review discussions or counseling sessions are

inaccurate, the rated employee should note that in Section VI and/or in

Section X. Such disagreements should not prevent an employee from

acknowledging receipt of the EER in Section III. By signing Section III, the

employee merely acknowledges receipt of the EER, not agreement with its

contents.

SECTION III. ACKNOWLEDGMENT OF RECEIPT

The rated employee should electronically sign and date the cover page to

acknowledge receipt of a copy of the EER. The signature does not indicate

agreement with the contents of the EER or limit in any way the right of the

employee to object to it. If the EER is not completed, signed, and returned

after five calendar days by the rated employee, a copy of the unsigned

rating is to be submitted by post/bureau to HR/PE for the employee's Official

Performance Folder (eOPF) with a covering memorandum to explain the

absence of signature. In cases where the employee has not signed

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acknowledging receipt of the EER, the review panel should comment on the

circumstances in a review panel statement attached to the EER.

SECTION IV. REVIEW PANEL STATEMENT

Bureau and post review panels review EERs before the reports are submitted

to HR/PE. They ensure that reports are completed in accordance with

regulations and these instructions. Review panel functions are:

(1) Technical - reviewing EERs for inadmissible comments and

changing or deleting inadmissible material; confirming that regulations and

instructions are correctly applied and, if not, returning them for correction;

and

(2) Advisory – returning reports that lack sufficient examples of

performance to substantiate comments or that appear to lack internal

consistency. The panel must try to have deficiencies corrected. If the effort

is unsuccessful, the panel should note the suggested revisions in Section IV

of the EER and any reasons for their rejection. A continuation sheet may be

used.

(3) Administrative -- if an evaluation is submitted to HR/PE after the

due date, the panel should indicate in Section IV C who was responsible for

the delay.

Any revision by the rater should be shown to the reviewer and must be

shown to the rated employee. A revision of the reviewer’s statement must

be shown to the rated employee. The employee may then revise Section VI

or supplement the narrative in Section X.

If the rated employee's description of accomplishments or optional

statement contains negative or pejorative comments concerning the rater or

reviewer, or raises significant questions of fact, the panel must provide the

employee the opportunity to revise these comments. If the employee

declines to do so, the review panel may invite the rater or reviewer, as

appropriate, to comment. Any such comments must be shown to the

employee, who will have the opportunity to make a final statement. These

supplemental statements must be attached to the evaluation report.

Although the review panel has the primary responsibility to check for

negative and pejorative comments, if HR/PE identifies such comments it will

follow the procedure outlined above.

If an evaluation is submitted to HR/PE after the due date, the panel should

indicate in Section IV C who was responsible for the delay. Assistant

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secretaries, chiefs of mission, and their equivalents may opt not to submit to

review panels the evaluations they prepare on their deputies. If this

provision is invoked, the appropriate Bureau or Post official submitting the

EER should so annotate in the review panel statement section.

SECTION V. POSITION DESCRIPTION, RESPONSIBILITIES,

AND SPECIAL CIRCUMSTANCES

(Completed by rater, reviewer, and rated employee)

Department of State guidance requires that all employees and their

raters/reviewers must have a separate detailed Work Requirements

Statement discussed and signed by the rated employee, rater, and reviewer

within the first 45 days of the EER cycle or arrival at new position. This

document is not part of the formal EER but should form the basis for Section

The rater should complete Section V within 45 days of the beginning of the

rating period, in collaboration with the rated employee and with the

concurrence of the reviewing officer.

Position Description: The rater should briefly explain the rated employee's position

and where it fits in the formal staffing pattern. The rater should explain the

employee’s rating and reviewing responsibilities for other employees and the level

of financial or other Department resources for which the rated employee exercises

operational responsibility.

CORE WORK RESPONSIBILITIES: There are two sections

within this box.

Part 1: The first sentence is pre-determined and must be included in all

EERs. The security section is a drop box dependent on the employee’s

personal grade. There is space for 1-3 lines for the employees’ broad core

work responsibilities.

Part 2: Goals/Specific Objectives - This section sets out the broad goals

and specific objectives, which guide the employee’s performance for the

rating period. They should be listed in priority order, and reflect a clear

appreciation for Mission, Bureau, or Department goals. They should be

realistic and realizable.

SPECIAL CIRCUMSTANCES

Here the rater should describe any unusual, unexpected, or unpredictable

circumstances that developed during the rating period and that significantly

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altered operational conditions that affected the ability of the employee to

perform his/her job responsibilities and accomplish his/her goals and

objectives. This does not include situations that existed at the start of the

rating cycle or could reasonably be expected to occur during the rating cycle.

SECTION VI. DESCRIPTION OF ACCOMPLISHMENTS

Rated employees must describe their most significant individual and

collaborative accomplishments during the rating period. Employees should

provide a factual description of outcomes achieved and how these outcomes

advanced Mission or Department goals. Employees should not self-appraise

their own performance.

The rater and reviewer may suggest changes in this section. The rated

employee may accept or decline such suggestions.

SECTION VII. EVALUATION OF PERFORMANCE AND

POTENTIAL

Section A. Appraisal

The rater has primary responsibility for assessing the rated employee’s

accomplishments in the areas of policy leadership, program and project

management, and interpersonal relations (Informational, Operational, and

Relational Effectiveness). The rater should document all performance. If

the employee did not fulfill his/her work responsibilities or did so in a

manner that did not meet expectations, the rater must cite specific

examples. If the employee was fully successful, the rater must document

whether the rated employee has demonstrated the potential to succeed if

assigned higher-level responsibilities, and what additional skills the

employee should work on to perform most effectively in future assignments.

The rater must use specific examples to address the employee’s

performance and potential in the areas of informational effectiveness,

operational effectiveness, and relational effectiveness (see Core Precepts for

further guidance on these three effectiveness elements, and their

relationship to the six core competency groups). The rater should focus on

accomplishments and results and comment on how well the employee has

integrated the six competencies into areas of effectiveness to accomplish

his/her goals.

All jobs require equal employment opportunity (EEO) leadership and adherence to

EEO principles is a mandatory work responsibility. Raters should discuss an

employee's EEO leadership and commitment to diversity and inclusion, if he or she

has demonstrated it, or document performance that suggests less than full support

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for EEO objectives and diversity and inclusion efforts, providing at least one

example to support either kind of statement.

All jobs require sound security awareness. Raters must comment on any

pattern of failure to meet the Department’s core security awareness

requirements.

If the rated employee is a supervisor, including supervision of locally

employed staff, the rater's comments should describe the employee’s

effectiveness as a supervisor, including developing subordinates, mentoring,

and concern for morale (including issues of work/life balance), as well as

efforts to support and/or increase diversity and inclusion within the section.

Any deficit in performance of required supervisory responsibilities should

also be documented, such as: failure to comply with performance appraisal

requirements; lack of equity in the delegation of assignments, counseling,

recommendations for training and placement, and recognition of

achievements of subordinates; failure to foster an inclusive environment that

respects diversity; and failure to establish or maintain effective and

appropriate management control systems. In particular, supervisors have a

responsibility to address any misconduct of subordinates and failure to do so

should be documented in the EER. In discussing performance, work done for

other agencies or outside the rater’s personal supervision may be cited,

drawing as appropriate on any evaluations submitted by the beneficiaries of

the rated employee’s work.

Section B. Developmental Area

During the rating period, the rater must periodically provide guidance to the

employee on any area that requires focused professional attention, including

any areas where the employee is not performing to the expected level.

In the EER, the rater must document the area where the employee should

focus most attention to be fully successful at his/her current level or to

succeed in higher-level assignments in the future. The area must be linked

to one of the six core competency groups. The rater must justify the area

with one or more examples. The rater cannot use this section to cite a need

for formal or informal training (as opposed to substantive knowledge or

technical expertise).

Section C. Summary Appraisal

For all employees, the rater must say whether the employee’s performance

was satisfactory or better. In the case of tenured employees, if the

performance was unsatisfactory, the rater must comply with 3 FAH-1 H-

2814.3 and all other provisions to which the section refers. For untenured

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employees, if the performance was unsatisfactory the rater must comply

with 3 FAM 2246 and all other provisions to which the section refers. A rater

may not assign an overall unsatisfactory rating unless the employee has

previously been advised of the areas of performance which are inadequate

and has been given a reasonable opportunity (normally 30 to 60 days) and

adequate guidance to remedy these deficiencies. In addition, for untenured

employees, if the rater assigns an unsatisfactory rating, the EER must be

forwarded directly to HR/PE. For untenured employees, the rater must also

indicate whether the employee is recommended for tenure.

Section VIII. Review Statement

The reviewer must independently assess the rated employee's preparedness

for assuming positions of greater responsibility, citing examples of

performance, and must not rely solely on the views of the rater. The

reviewer must describe the employee’s relations with his/her rater, and

document the employee’s record of working collaboratively with peers and of

supporting the professional development of subordinates. If the reviewer

disagrees with the evaluation of the employee by the rater, or if relations

between the rater and employee are strained, the reviewer must make this

clear.

The reviewer shares responsibility for ensuring that the employee is fairly

rated. The reviewer may comment on the adequacy and candor the rater

showed in preparing the report.

Section IX. Performance Pay

SFS Members – Performance Pay: Raters should evaluate SFS employees for

performance pay. Such pay is based solely on performance during the most

recent rating period and specifically on established performance pay criteria

as specified in the Procedural Precepts for Performance Pay Boards. Those

criteria are:

(1) The relative value of the member's achievement to the accomplishment

of the Department's mission;

(2) The degree of difficulty inherent in successful achievement by the

member;

(3) The extent to which achievement was characterized by strong executive

leadership and significant contributions in the formulation of agency policies

and programming; and

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(4) Effective supervision and development of subordinates.

Section X. Optional Statement by the Rated Employee

Rated employees may address any activities or problems that they believe

have not been covered adequately. The rated employee should use this

section to identify a disagreement with the rater in Section II regarding the

dates of establishment of work responsibilities or performance review

discussions. If additional space is required, continuation sheets may be

attached. This space should not be used as a continuation of Section VI’s

Description of Accomplishments.

The employee must be provided five calendar days from the date of receipt

of the final EER to review it and prepare a statement. The employee does

not have the right to amend this statement at a later date except in

response to changes made in the rater's or reviewer's sections. If the rated

employee disagrees that counseling sessions have been held, he or she may

use this section to explain the disagreement. Neither the rater nor reviewer

has a right to see the employee's statement. See section on review panel

responsibilities above for exceptions to this rule.

PERFORMANCE EVALUATION REFERENCES

Regulations

3 FAM 2810 and 3 FAH-1 H-2810 - See below for instructions on

inadmissible comments.

Decision Criteria for Promotion

See Core Precepts at http://collaborate.state.sbu/sites/pmr/Pages/default.aspx

EEO

Department of State policy is to provide equal opportunity and fair and

equitable treatment in employment to all persons without regard to race,

color, religion, sex, national origin, age, disability, political affiliation, marital

status, or sexual orientation.

Additional information can be obtained from 3 FAM 1500 or by contacting

S/OCR.

INADMISSIBLE COMMENTS

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Inadmissible comments may not be included in any section of the evaluation

report, or in other forms of evaluative material. Raters and reviewers, as

well as review panels, must ensure that employees are not disadvantaged,

directly or indirectly, for reasons of race, color, religion, sex, age, marital

status, national origin, disability, reasonable accommodation for disability,

sexual orientation, or means of entry into the Foreign Service. Stereotypes,

group assumptions, and sexist or ethnic comments are inadmissible.

The following subjects are inadmissible in any part:

(1) Reference to race, color, religion, sex (does not extend to the use of Mr.,

Mrs., Ms., or first names or personal pronouns), national origin, age,

disability, reasonable accommodation for disability, and sexual orientation;

(2) Ranking by former Selection Boards or impending selection out;

(3) Physical characteristics and personal qualities that do not affect

performance or potential;

(4) Marital status or plans, or references to spouse or family;

(5) Retirement, resignation, or other separation plans;

(6) Reference to job sharing and telecommuting;

(7) Grievance, equal employment opportunity, or Merit Systems Protection

Board proceedings;

(8) Method of entry into the Service;

(9) Reference to private U.S. citizens by name;

(10) Participation or nonparticipation of Foreign Service personnel, in any

organization which exists for the purpose, in whole or in part, of dealing with

foreign affairs agencies concerning grievances, human resources policies,

and practices;

(11) Ratings for earlier periods prepared by other supervisors;

(12) Reluctance to work voluntary overtime;

(13) Leave record, except in the case of unauthorized absences;

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(14) Letters of reprimand;

(15) Negative reference to use of the Dissent Channel or direct or indirect

reference to, or consideration of, judgments in dissent channel messages as

a basis for an adverse evaluation of performance or potential.

When the rated employee's expression of dissenting views on policy, outside

of the dissent channel, raises substantial questions of judgment or

obstructionism relevant to the employee's performance, it may be the

subject of comment. However, general comment may not be used to get

around the proscription of this section. Specific instances must be cited.

(16) Negative or pejorative discussion of the performance of another

identifiable employee;

(17) Specific identification by rating or reviewing officers of disability or

medical problem (including alcoholism, drug abuse, or rehabilitation efforts);

Although the details or specific identification of a medical problem are

inadmissible in the evaluation report, general reference may be made to

confirmed knowledge of a medical problem to the extent it affects job

performance. Rated employees may discuss their own health problems in

specific terms if rating or reviewing officers have made references to such

problems, or to explain or clarify adverse comments in a report.

Employees, raters, review panels, and HROs are encouraged to consult

HR/PE with questions about what may or may not be admissible.

(18) Reference to academic degrees, titles, or specific institutions of higher

learning (except that physicians may be referred to as "Dr."); or

(19) Outside activities that are not relevant to performance or post

effectiveness.

PRIVACY ACT STATEMENT

Employee Evaluation Reports are subject to strict confidentiality under section 604

of the Foreign Service Act of 1980 and the provisions of the Privacy Act, 5 U.S.C.

552a.

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