Department of Medicine
Probationary Performance Evaluation
Name of employee:
EMPL ID:
Employee Category:  Academic Staff
Title:
 University Staff
Division Name:
Date:
Appointment Start Date:
Probation End Date:
Supervisor/PI:
Supervisor: Check rating box to indicate your appraisal of employee's performance in each area over the past 12 months.
Exceeds standard (ES):
Performance is exceptional in all areas and is recognizable as being far superior to others. Results clearly
exceed most position requirements. Performance is of high quality and is achieved on a consistent basis.
Meets standard (MS):
Competent and dependable level of performance. Meets performance standards of the job.
Needs Improvement (NI): Performance is deficient in certain areas. Progress is necessary to meet job requirements. Results are
generally unacceptable and require immediate improvement.
Midpoint Rating
If employee ‘Exceeds Standard’ OR ‘Needs Improvement’, please
explain in comments section.
ES
MS
NI
Final Rating
ES
MS
NI
Judgment/Independence
Comments:
Productivity/Accomplishments
Comments:
Dependability/Reliability
Comments:
Creativity/Initiative
Comments:
Job Knowledge/Rate of Learning
Comments:
Work Habits/Work Quality
Comments:
Interpersonal/Communication Skills
Comments:
Supervisor: Please refer to the most recent “Expectations and Goal Setting” discussion to complete the sections below.
What were the specific performance expectations and goals agreed upon for the evaluation period?
Please give an OVERALL appraisal of the employee's job performance. Has his/her performance met expectations?
Please assess the employee’s success in achieving his/her specific goals.
OVERALL, what can the employee do to increase her/his value to the organization?
Employee comments:
Supervisor's signature: ___________________________________
Date: _______________
This evaluation has been discussed with me. I understand that I may submit a written response to Human Resources within 30 days of
receipt of this evaluation, to be filed with the evaluation.
Employee's signature: ___________________________________
Date: _______________
**SUPERVISOR: Following completion of each evaluation, please send a copy of the signed form to DOM Human Resources
(mail: 310 N Midvale Blvd, Suite 304, Madison, WI 53705; fax: 608-262-4433;
email: HR@medicine.wisc.edu (or directly to your division’s HR contact)).**