PEER INPUT FORM
COLLEAGUE’S NAME:
This internal form was developed to provide a broader perspective to our department employees as part of the
performance appraisal process. How an individual functions within this department is an important component of each
individual’s job. Your honest input can provide important information on perceived strengths and areas of improvement for
your colleague. The information will only be provided to your colleague in summary form. Feel free to speak with your
colleague directly about your perception of his/her performance. Please respond to the following items based on first-hand
information in the professional context.
SECTION I
1. Frequency of interactions with this colleague:
_____ Several times a day
_____ Daily
_____ Weekly
_____ Monthly
_____ Other
2. Depth of interactions with colleague:
_____ In-depth problem solving
_____ Special projects
_____ Referral to or from colleague
_____ Routine process/service interaction
_____ Other
On a scale from 1 – 6 rate this individual’s performance as you have observed it. (CIRCLE ONE)
1 = Goes well beyond what is expected & provides an excellent professional model for others
2 = Goes beyond what is expected and provides very good customer service
3 = Meets all department and customer expectations and needs
4 = Meets most department and customer expectations and needs
5 = Meets most department and customer expectations however has some level of learning to do, or needs
some improvement in one or more areas of performance
6 = Requires effort, to improve in this area in order to be successful
SECTION II
1. Information source:
1 2 3 4 5 6
Reliable source of relevant information (e.g. policy, procedures, resources etc.)
Comments:
2. Data integrity:
1 2 3
4 5 6
Provides and retrieves accurate and timely data (e.g. memos, reports, input on projects etc.)
Comments:
3. Dependability:
1
Punctual with assigned tasks/meets commitments
Comments:
2
3
4
5
6
4. Communication:
1 2 3 4 5 6
Communicates important information in a timely manner, when there is a need to know
Comments:
5. Team work:
1
2
1
3
4
5
6
Demonstrated willingness to assist colleagues with various projects/tasks (assigned projects as well as
unassigned where help is needed)
Comments:
6. Customer service:
1 2 3 4 5 6
Demonstrates willingness to assist customers and/or make appropriate referrals
Comments:
7. Flexibility:
1 2 3 4
Willingly alters plans and personal work style to fit circumstances
Comments:
5
6
8. Initiative:
1 2 3 4 5 6
Able to identify issues and propose solutions without being asked or instructed to do so
Comments:
9. Follow-through:
1 2 3 4 5 6
Sees projects/processes through to completion and meets verbal and written commitments
Comments:
10. Supervision:
Provides good leadership and direction
Comments:
1
2
3
4
5
6
11. Stress:
1 2 3 4
Manages the stress of the position productively and appropriately
Comments
5
6
12. Any suggestions that would make this person a more effective department member?
OTHER COMMENTS:
* If you have indicated that performance was less than satisfactory in any area, have you discussed this with
the individual involved? As a member of the team, helping co-workers learn and grow is an important part of
your role in making our entire department more successful. If you have not done so, please consider doing so
or at least share enough information with his/her supervisor to allow that person to better assist/develop your
colleague.
Please complete the form and e-mail your response back to:
by
. Thank you.
No unsigned or unidentified feedback is accepted; your return e-mail will serve as your signature.
Date
Rev. 7/01
2