The
University
of
Rochester
NONEXEMPT
PERFORMANCE ASSESSMENT and
GOALS / OBJECTIVES FORM
Employee Name:
Employee ID:
Division/Dept. #:
Dept. Name:
Current Job Title:
Evaluator Name:
Date of Evaluation:
Date of LAST Evaluation:
SECTION I
ACCOMPLISHMENTS - Goals accomplished since last performance review and/or progress
to date on those not completed:
List additional accomplishments that were beyond the established goals from previous
performance review:
Evaluator or customer comments relating to accomplishments:
SECTION II (CAN BE CUSTOMIZED)
CORE COMPETENCIES. This section should reflect the employee’s performance using their specific
job competencies. For examples of behaviors that align with each of the core behavioral competencies,
see the generic competency model: Clerical/Support Staff/Paraprofessional, Research/Technical,
and/or Supervisory.
Rate each of the behaviors, using the scale:
E
(Exceeds
Expectations)
Consistently exceeds standards, proactively addresses issues,
takes appropriate initiative; is willing to assist whenever needed.
May engage in mentoring others within the department.
M (Meets
Expectations)
Consistently meets the majority of or all standards. Opportunities for
learning and improvement support continued success.
NI (Needs
Improvement)
The majority of important standards are not met or are partially met.
Opportunities for learning and improvement are critical in order to
achieve success; will need to follow a specific developmental plan.
CUSTOMER SERVICE
E __
M __
NI __
Participates in creating and maintaining an environment of service excellence, continually improving
internal/external customer satisfaction and quality results. (SMH Employees must meet the I CARE
Values and Standards)
Comments:
INTERACTION WITH OTHERS/COMMUNICATION
E __
M __
NI __
Uses effective listening, verbal, and written skills to provide necessary information clearly and in a
timely fashion. Is flexible and willing to listen to ideas that are different from their own in order to
promote understanding.
Comments:
EXPERTISE/CONTINUOUS LEARNING
E __
M __
NI __
Demonstrates knowledge and skills related to the functional area and exhibits commitment to
developing personal and professional abilities.
Comments:
RESOURCEFULNESS / RESULTS
E __
M __
NI __
Uses available resources to assist in day-to-day operations to produce quality products/services.
Demonstrates a sense of organizational stewardship.
Comments:
PERSONAL ACCOUNTABILITY
E __
M __
NI __
Takes responsibility for own work in completing tasks. Assists others so that the resources,
assistance or support is provided to achieve success in their daily work.
Comments:
SECTION III
Use this section to outline goals for the upcoming year, including specific time frames in which they
should be completed, resources needed to reach the goal, and progress reporting mechanism
(weekly e-mail, quarterly formal report, etc.).
GOAL
ANTICIPATED
TIME FRAME
RESOURCES NEEDED
PROGRESS
REPORT BY
SECTION IV
Use this section to provide a summary of the employee’s overall performance and use one final
overall rating of either “E” – Exceeds Expectations, “M” – Meets Expectations, or “NI” – Needs
Improvement. If the overall rating is “Needs Improvement,” contact your HR Representative at the
Medical Center or on the River Campus to assist in the creation of a performance improvement plan.
Overall Performance Summary
Exceeds
Expectations
__
Meets
Expectations
__
Needs
Improvement
__
Comments:
Employee Signature* _____________________________________ Date ________________
*Signature indicates that the evaluation has been discussed and does not necessarily signify concurrence. A
response to this review may be made on a separate sheet of paper.
Evaluator Signature ______________________________________ Date ________________
Department Head (Optional) ____________________________________________________
Rev.5/09