INDIANA UNIVERSITY-PURDUE UNIVERSITY FORT WAYNE
PERFORMANCE FEEDBACK
Name of Employee________________________________Position Title
Department__________________________________ Date________Supervisor
__
Performance Update Worksheet Meetings Held (Please provide dates):___________________________________
Please Choose One: Self Evaluation
Supervisor Evaluation
Part I: Job Specific Responsibilities
Write the position summary found in the job description in the space provided below.
Position Summary:
From the job description, please list in the order of importance the most critical job specific responsibilities and
assign a rating for each one. You must list a minimum of 5 responsibilities. Please provide comments as needed.
5 = Outstanding: Employee consistently exceeds performance standards.
4 = Exceeds Expectations: Employee meets and often exceeds performance standards.
3 = Meets Expectations: Employee consistently meets the performance standard.
2 = Improvement Needed: Employee meets but often falls short of performance standards.
1 = Unacceptable: Significant improvement required.
*(5) Outstanding and/or (1) unacceptable ratings require a comment.
Job Specific Responsibilities
Rating (See rating
scale above)
*1 2 3 4 *5
Comments
1
Part II: Job Competencies
Instructions: Select the appropriate rating for each performance dimension according to the standards and expectations of
the job. Give specific examples of performance behaviors to support ratings based on the following scale (O,E,M,I,U):
Rating Key:
5 = Outstanding: Employee consistently exceeds performance standards.
4 = Exceeds Expectations: Employee meets and often exceeds performance standards.
3 = Meets Expectations: Employee consistently meets the performance standard.
2 = Improvement Needed: Employee meets but often falls short of performance standards.
1 = Unacceptable: Significant improvement required.
Job Knowledge/Skills
Rating O E M I U
Effectively applies job knowledge/skills and keeps current of new developments and technologies.
Specific examples:
Organization
Rating O E M I U
Effectively manages time, materials, equipment, and other resources to plan work to meet deadlines.
Specific examples:
Teamwork
Rating O E M I U
Shares information and works cooperatively with others. Willing to undertake new assignments.
Values the differences brought to the group by individual team members. Specific examples:
Customer Support
Rating O E M I U
Identifies customer, both internal and external, needs and responds with timely and accurate service ; follows through on
commitments.
Specific examples
2
Problem Solving
Rating O E M I U
Obtains and evaluates facts to determine problems, identifies alternative solutions and develops strategies to achieve results and
makes sound job-related decisions. Specific examples:
Communication
Rating O E M I U
Presents clear and accurate information, verbally and/or in writing, actively listens to others for understanding and deals effectively
with difficult situations. Specific examples:
Initiative
Rating O E M I U
Shows resourcefulness and creativity in meeting job objectives. Modifies/develops new ideas and procedures to meet changing
circumstances. Specific examples:
Safety
Rating O E M I U
Assesses the work site for hazards and maintains a safe and organized area. Plans a job with safety concerns in mind and corrects
unsafe conditions as needed. Keeps up with safety regulations and considers the safety of others . Specific examples:
Leadership (for employees with supervisory responsibility)
Rating O E M I U
Effectively applies supervisory skills (counseling, feedback, communication and coaching) to create a positive and productive work
climate. Specific examples
3
Part III: Developmental Goals
Accomplishments During Current Performance Period:
Developmental Goals / Activities
Time Period
Developmental Plan for Next Performance Period:
Developmental Goals / Activities
Time Period
4
Part IV: Comments and Signatures
Overall assessment of performance:
Outstanding
Exceeds Expectations
Meets Expectations
Improvement Needed
Unacceptable
Supervisor’s Comments:
Employee’s Comments
Employee acknowledgment: I understand that my signature acknowledges that this evaluation has been discussed with me and that
my signature does not necessarily indicate agreement with the evaluation.
Employee
Date:
Supervisor
Date:
5