Jacksonville State University
Performance Review Summary Form
(to be completed for all staff employees and forwarded to Human Resources by April 1, 2015)
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Employee ID#
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Review Period:
1/01/2014
To 12/31/2014
Performance Review Key Elements and Ratings:
Rating Key:
1 - Rarely Achieves Expectations (supporting documentation required)
2 - Sometimes Achieves Expectations
3 - Fully Achieves Expectations
4 - Consistently Exceeds Expectations (supporting statement/documentation required)
Accomplishments – the extent to which the employee meets expectations in performing the job
functions of his/her position as defined in the job description.
Choose an item.
Service and Relationships – the extent to which the employee’s behaviors are directed toward fostering
positive working relationships in a diverse workplace, respect for one’s fellow workers, and cooperation
with students, customers, and visitors.
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Accountability and Dependability – the extent to which the employee contributes to the effectiveness
of the department and the overall mission of the university (NOTE: Time off approved under FMLA may
not be considered.)
Choose an item.
Adaptability and Flexibility - the extent to which the employee exhibits openness to new ideas,
programs, systems, and/or structures.
Choose an item.
Decision Making and Problem Solving – the extent to which the employee makes sound and logical jobrelated decisions that are in the best interest of the University.
Choose an item.
Page 1 of 3
Staff Performance Review Summary Form
Revised: November 2014
Average Rating – is determined by adding the assigned ratings for each section and dividing the total by 5. List
the ratings below for each section and place the average number on the line below.
Accomplishments:
Service and Relationships:
Accountability and Dependability:
Adaptability and Flexibility:
Decision Making and Problem Solving:
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Average Rating:
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Level:
____________ (for human resource use only)
1.
Goals and Objectives have been developed and discussed with employee?
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2.
Job Duties and Professional Growth Goals have been discussed with employee?
Choose an item.
3.
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Appropriate Performance Improvement has been discussed with employee?**
Choose an item.
Date: Click here to enter text.
**Employees who have a rating of “rarely achieves expectations” in any section of the performance
summary must be given a performance improvement plan (PIP). Please consult with Human
Resources to develop a PIP.
Please attach any comments (comment page provided) or required supporting documentation.
Supervisor's Comments: (This section may be used as documentation for the Consistently Exceeds
and/or Rarely Meets Expectations ratings.)
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Staff Performance Review Summary Form
Revised: November 2014
Employee's Comments: (Employees may provide additional comments to be retained with this
document in the personnel file.)
By signing below, I acknowledge that I have participated in the staff performance review process and have received a copy
of the review. PLEASE SIGN IN ORDER LISTED BELOW.
(1)________________________
_______________________
Supervisor’s Signature
Date
(2) _________________________
Director/Dept. Head/Academic Dean/
VP/Assoc. VP/Vice Provost/Provost/President
_________________________
Date
(3)__________________________
Employee's Signature
_________________________
Date
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Staff Performance Review Summary Form
Revised: November 2014