STAFF PERFORMANCE APPRAISAL MAIN CAMPUS (PSA, Non-Union/Salaried and Hourly)
Note: This form may be used for any non-managerial, non-supervisory jobs (both professional and staff level) and may be customized to meet/reflect the needs of the particular
department/unit in which the employee works. MC – PSA/Non-union/Salaried and Hourly
Employee Name:
Rocket #:
Position Title:
Date:
Department:
Policy #:
3364-25-45
Evaluation Period:
Evaluation Type:
Mid-Probation
Annual
Sum of the
Weighted
Scores:
End Probation
Special
Mission Statement: The mission of The University of Toledo is to improve the human condition; to advance knowledge through excellence in learning, discovery and engagement; and
to serve as a diverse, student-centered public metropolitan research university.
Department Statement: The mission of The Department of…
Total Possible Weighted Score
Pillar 1
Pillar 2
Pillar 3
Pillar 4
Pillar 5
0.50
0.20
0.10
0.10
0.10
Weighted Score by Pillar
Average Weighted Score (round to
tenth) e.g. 3.2 vs. 3.266
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RATINGS:
5 - Distinguished Contributor: An employee who regularly exceeded expectations and demonstrated extraordinary performance, including achievement of
objectives and demonstration of core pillars. Personal contributions were recognized and applauded by others.
4 - Highly-Valued Contributor: An employee who consistently exceeded expectations throughout the year, going beyond achievement of objectives and
demonstration of core pillars, anticipating issues, and acting proactively.
3 - Valued Contributor: An employee whose performance met and occasionally exceeded all expectations for achievement of objectives and demonstration of
core pillars.
2 - Improving Contributor: An employee whose performance occasionally, but not regularly, met expectations for achievement of objectives and
demonstration of core pillars in selected areas and requires some improvement. (This rating requires an action plan).
1 - Non-Contributor: An employee whose performance did not meet minimum expectations or requirements of the position. Improved performance is required
for continuation in this position. (This rating requires an action plan).
*The overall performance rating is the average of your rating for each individual core pillar.
CRITERIA PILLARS
RATING
COMMENTS
Foundation/Pillar 1: Core Responsibility: The employee successfully completes the fundamental
responsibilities of the job description and fulfills the basic expectations of the role. The employee’s
daily actions support the strategic direction of the department/division.
Core Duties: (Insert Job Description duties. Please see template).
Pillar 2: Customer Service Excellence: The employee demonstrates a noble commitment to
students and other members of the University community. The employee consistently demonstrates
to students and other members of the University community actions that display the employee’s
commitment to provide relief, support, continuous improvement, problem solving, and customer,
student centeredness.
Pillar 3: Nimble and Responsive: The employee demonstrates flexibility and adaptability while
also responding to all requests and inquiries in a timely manner. The employee focuses on moving
projects quickly from planning phase to implementation.
Pillar 4: Professionalism and Respect: The employee consistently acts and behaves in a manner
that demonstrates the culture of dignity and respect that is required in a world-class University and
Health Center.
Pillar 5: Communication Effectiveness: The employee communicates with clarity, openness and
transparency, ensuring all stakeholders receives appropriate information at all times.
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Core Duties: Template
DIMENSION/CRITERIA (Primary Duties, stated in the job description
that fulfills the Pillar 1/Foundation, and any related accreditation
requirements.) Please complete as appropriate for position
Rating (Tally
and enter
average into
Pillar 1/
Foundation).
Comments
1.
2.
3.
4.
5.
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Supervisor Comments:
Employee Comments:
This appraisal was reviewed with me and I received a copy of it.
Employee Signature
Date
Appraiser Signature, Credentials, and Title
Date
Appraiser Printed Signature, Credentials, and Title
Date
Second level Appraiser Signature, Credentials, and
Title (Required unless first level is a Chair)
Date
Second level Appraiser Printed Signature,
Credentials, and Title (Recommended not required)
Date
Is this an addendum to any other performance tool?
 Yes
 No
Please Attach Signed Job Description.
ACTION PLAN FOR IMPROVING JOB PERFORMANCE (for any pillar with a rating of 2 or less)
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This memo is intended to serve as an action plan and is the culmination of a pattern of job performance which is inconsistent with UT’s values.
I want to work with you and include any resources you feel are not listed here under the specific areas of performance needing development. I recognize that you
may have additional ideas on how to improve your performance. Therefore, I encourage you to provide your own personal improvement suggestions.
Performance Issues
Pillar Number:
Describe in detail the area in need of improvement:
Management’s Expectations:
Resources needed to improve performance:
MEASUREMENT
I will be able to monitor your progress in this area by (describe how you will know the employee is on the right track)
Consequences if failure to improve
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If you have any further incidents of the same or similar nature within _____________ from the date of this action plan, you may be disciplined up to an including
termination.
Follow up and Personal Commitments
(Department Manager) commits to:
Employee Signature
Date
Manager Signature, Credentials, and Title
Date
Please Attach Signed Job Descriptions
Copy to employee, manager and original to HRTD
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