Department of Medicine Comprehensive Performance Management Form
Name of employee:
EMPL ID:
Employee Category:  Academic Staff
 Limited Appointee
Title:
 University Staff
 Other
Division Name:
Date:
Appointment Start Date:
Supervisor/PI:
PART 1:
DUE DATE:
6/30/16
SUMMARY EVALUATION
Supervisor: Check rating box to indicate your appraisal of employee's performance in each area over the past 12 months.
Exceeds standard:
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:
Competent and dependable level of performance. Meets performance standards of the job.
Needs Improvement: Performance is deficient in certain areas. Progress is necessary to meet job requirements. Results are
generally unacceptable and require immediate improvement.
If employee ‘Exceeds Standard’ OR ‘Needs Improvement’, please
explain in comments section.
Exceeds
Meets
Needs
Standard
Standard
Improvement
Rating at Last
Evaluation
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 current year?
Please give an OVERALL appraisal of the employee's job performance. Did his/her performance meet expectations this year?
Please assess the employee’s success in achieving his/her specific goals for the past year.
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: ___________________________________
PART 2:
Date: _______________
EXPECTATIONS AND GOAL SETTING
Responses should be formulated through interactive discussion between the supervisor and employee, and referred to throughout
the year to assess progress. Both parties should keep a copy of signed form.
Describe any major changes in the employee’s duties / work priorities over the past year, and/or anticipated changes in the next year.
What are the performance expectations for the employee over the next year? How will successful performance be evaluated?
What specific goals will the employee work to achieve in the next year?
Is additional training/development needed to achieve these goals? If yes, please describe need(s) & specific strategies to address them.
Additional comments:
We have discussed and agree upon the responses stated above.
Employee’s signature: ___________________________________
Date: _______________
Supervisor’s signature: ___________________________________
Date: _______________
**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)). MUST BE SUBMITTED BY JUNE 30TH**