ANNUAL PERFORMANCE REVIEW 2015-2016
Name:
Division:
Supervisor:
Title:
Department:
Fiscal Year: 2015-2016
Performance Rating Scale
1 = Need for Development
Performance may meet some but not all requirements on a
consistent basis. Critical goals require more than usual
supervisor follow-up and direction. Results and contributions are
below those of a fully trained competent employee. Action on
performance improvement areas is required.
2 = Competent
Performance consistently meets and sometimes exceeds job
requirements. All critical goals are achieved and behaviors
exhibited are valued and effective. Over the review period,
employee has made the expected contributions to the
department. Consistently met expectations for the performance
of duties and responsibilities identified.
3 = Exemplary
Performance and demonstrated expertise is consistently at a
superior level. Employee achieves outstanding results and
models effective behaviors that are an inspiration to
others. Over the review period, employee has consistently
made exceptional or unique contributions to the
department. Regularly exceeded expectations for the
performance of duties and responsibilities identified.
SECTION 1. Institutional Values and Competency Evaluation
At Xavier, we celebrate a passion for mission and incorporate those values into one’s performance. Competencies are demonstrated knowledge, skills, abilities and motivations. Ratings are based on
observations of the immediate supervisor with input from others whom the employee worked with during the review period.
INSTITUTIONAL VALUES
Magis – focus on students; encourage and model personal
Cura Personalis – encourage balance in our professional and personal
accountability and high performance with the common good in mind; use
resources efficiently and strategically; act with integrity
lives; build trust through ongoing feedback; recognize and utilize individual
styles and skills; treat people with respect regardless of position
Reflection– are self-aware and understand strengths and weaknesses;
Solidarity and Kinship – develop strong relationships within and
Service Rooted in Justice and Love – contribute service time in
outside of Xavier; value diversity of people, ideas and ways of thinking;
motivating others and offer assistance with your talents
the way of treasure and talents with others; support those in need; help
others become men and women for others
encourage and model personal growth, evaluation and learning;
challenge the process and status quo as appropriate; accept
responsibility for our actions
Discernment – make important decisions with broad consultation;
consider the full impact of our actions; manage conflict constructively
SECTION 1. Xavier’s Institutional Values Comments:
Please provide specific examples of how Xavier’s institutional values were exhibited in the work setting. Discuss strengths and opportunities for improvement. The employee should provide a selfassessment, indicating how they have given expression to Xavier’s mission through their work.
Supervisor Comments:
OVERALL VALUES RATING
Provide one overall rating from scale of 1-3
Supervisor
Employee Comments:
OVERALL VALUES RATING
Provide one overall rating from scale of 1-3
Employee
Xavier Performance Review Form
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ANNUAL PERFORMANCE REVIEW 2015-2016
CORE COMPETENCIES
Leadership – creating a healthy work environment that encompasses developing or promoting a workplace
climate conducive to productivity and self-motivation; trustworthy behavior by demonstrating through personal
behavior that one is ethical and trustworthy; clearly articulating goals and objectives to colleagues and direct
reports; results oriented, focuses work efforts on achieving positive results within one’s area of responsibility
Collaboration – Establishing and maintaining collegiality and cooperative working relationships with other
members of the University; Involving others by engaging colleagues, direct reports and other coworkers or
stakeholders by sharing information (e.g. through reports, meetings, presentations or by other means based on job
responsibility); coaching and supporting others in their skill building and by providing information, resources and tools
to enable them to be successful; soliciting input and asking for ideas and/or feedback from others in appropriate
settings such as meetings, phone calls and presentations
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Managing Work – effectively organizing and carrying out work processes to achieve individual and
organizational goals through necessary means such as setting priorities and making appropriate decisions to
complete assigned tasks while balancing urgency and important; making decisions and analyzing data and
information to make informed timely decisions and appropriately disseminating those decisions to others; and
problem solving through balancing facts and people issues effectively to resolve problems and meet
organizational concern
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Communicating – using non-verbal communication and showing respectful behavior toward colleagues and
others in the University; actively listening and focusing on the person speaking, asking questions and providing
feedback to ensure understanding; teaching and sharing knowledge and information with others; promoting dialogue
with others and uncovering and discussing concerns and objections
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Effecting Change – developing and supporting processes that bring
Job Specific Competency #1:
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Job Specific Competency #2:
about positive change in support of University’s goals; empowering others
with the ability to change processes that pose barriers to change; willing to
accept challenges and modify processes, procedures and behaviors as
needed; willing to take appropriate risks and make decisions based on
incomplete or ambiguous information
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Supervisor
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Supervisor
COMPETENCY RATING
Rate each competency on scale from 1-3
Employee
Supervisor
SECTION 1. Competency Evaluation Comments
Please provide specific examples of how Xavier’s core competencies were exhibited in the work setting. Discuss strengths and opportunities for improvement. The employee should provide a selfassessment of exhibiting these competencies at work.
Supervisor Comments:
OVERALL COMPETENCY RATING
Provide one overall rating from scale of 1-3
Supervisor
Employee Comments:
OVERALL COMPETENCY RATING
Provide one overall rating from scale of 1-3
Employee
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ANNUAL PERFORMANCE REVIEW 2015-2016
SECTION 2. Organization Goals & Job Responsibilities
Goals should be LINKED to Department and/or University goals and SMARTRR (Specific, Measurable, Attainable, Relevant, Timebound, Review/Adjust, and Rejoice in Achievements). Job
responsibilities are outlined in employee’s position description. This section is to allow you to evaluate ‘what’ employees have accomplished this year that includes a combination of goals and job
responsibilities.
Organization Goals
Goal:
Goal:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Goal:
Goal:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Goal:
Goal:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Goal:
Goal:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Section 2. Organization Goals Evaluation
Please document employee’s goals for the review period and provide comments of ‘what’ work was done to accomplish these goals. The employee should provide self-assessment of annual
accomplishments. The immediate supervisor will provide a rating based on documented results with input from others whom the employee worked with during the review period. Also include strengths and
suggestions for improvement.
Supervisor Comments:
OVERALL GOAL RATING
Provide one overall rating from scale of 1-3
Supervisor
Xavier Performance Review Form
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ANNUAL PERFORMANCE REVIEW 2015-2016
Employee Comments:
OVERALL GOAL RATING
Provide one overall rating from scale of 1-3
Employee
Job Responsibilities
Job Responsibility:
Job Responsibility:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Job Responsibility:
Job Responsibility:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Job Responsibility:
Job Responsibility:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Job Responsibility:
Job Responsibility:
Measure(s):
Measure(s):
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
RATING
Rate each competency on scale from 1-3
Employee
Supervisor
Section 2. Job Responsibilities Comments
Please document employee’s job responsibilities for the review period and provide comments of ‘what’ work was done to fulfill these responsibilities. The employee should provide self-assessment. The
immediate supervisor will provide a rating based on documented results with input from others whom the employee worked with during the review period. Also include strengths and suggestions for
improvement.
Supervisor Comments:
OVERALL JOB RESPONSIBILITIES RATING
Provide one overall rating from scale of 1-3
Supervisor
Employee Comments:
OVERALL JOB RESPONSIBILITIES RATING
Provide one overall rating from scale of 1-3
Employee
Xavier Performance Review Form
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ANNUAL PERFORMANCE REVIEW 2015-2016
Performance Rating Scale
1 = Need for Development
2 = Competent
Performance may meet some but not all requirements on a
consistent basis. Critical goals require more than usual
supervisor follow-up and direction. Results and contributions
are below those of a fully trained competent employee. Action
on performance improvement areas is required.
Performance consistently meets and sometimes exceeds job
requirements. All critical goals are achieved and behaviors
exhibited are valued and effective. Over the review period,
employee has made the expected contributions to the
department. Consistently met expectations for the
performance of duties and responsibilities identified.
3 = Exemplary
Performance and demonstrated expertise is consistently at a superior
level. Employee achieves outstanding results and models effective
behaviors that are an inspiration to others. Over the review period,
employee has consistently made exceptional or unique contributions to
the department. Regularly exceeded expectations for the performance
of duties and responsibilities identified.
Section 3. Overall Performance Rating
A single performance rating will be determined based on a combination of ratings in Section 1 & Section 2. Please check the box below that applies to the employee you are evaluating.
Need for Development
Employee Signature* / Date:
Competent
Exemplary
Supervisor Signature / Date:
(Signature indicates the material was reviewed and discussed)
*Note: Your signature does not necessarily indicate agreement with the contents of this form, but is a confirmation that you have met with your immediate supervisor to discuss your performance.
Completed review of my position description.
3/2013
Xavier Performance Review Form
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