SAMPLE
Name
Date
Title President/CEO
Date Employed
Name/Position of Evaluator
Appraisal Period: From
X Annual Performance Appraisal
To
Initial Probationary Performance Appraisal
Special Performance Appraisal (specify reason):
Other (specify reason):
Objective
The Purpose of a performance appraisal is to objectively evaluate an employee’s professional performance in accordance with the job description. The appraisal is also intended as a communication tool between the employee and the Chairman of the Board of Directors. The Chairman of the Board of Directors finalizes the Agency’s appraisal of the President and CEO.
The evaluation tool is designed to identify key responsibilities on an annual basis, oversight of performance measures in accordance with the corporation’s strategic, business and marketing plans, and skills or knowledge of the employee required by the position. An individual’s strengths and areas of development are identified. Executive and corporate goals are established to provide for the personal and business development of the agency. The overall performance rating should reflect the employee’s conformation to the position description
_______________________
President and CEO
______
Date
_____________________ _____
. Date
Chairman, Board of Directors

Performance Evaluation
DEFINITIONS
Exceeds Expectations Employee consistently performs beyond the established goals and objectives of his/her professional responsibilities. She/he makes contributions demonstrating creativity, leadership and initiative. Employee demonstrates a clear understanding of a shared responsibility for corporate values. Employee is viewed as a leader and role model for the position.
MEETS Expectations : Employee consistently performs all responsibilities of a position at or near full proficiency, meeting established objectives for the position. Employee is viewed by others in the organization and subordinates as fully knowledgeable of all aspects of the professional responsibilities. Employee is considered to have potential for continued growth and responsibility.
BELOW EXPECATIONS : Employee is not performing his/her responsibilities at a fully effective level. Those areas not being performed effectively are specifically identified in a corrective plan* (which will guide the employee and supervisor in a three month improvement process) or the employee should be discharged in accordance with his/her employment contract.

If a decision is made to develop a corrective plan, the supervisor will review progress toward successful completion on at least a monthly basis and the employee must be reevaluated at the end of the three months

:
1.
Responsible for the recommendation and execution of the programs approved by Parent Company and related entities’ Boards of Directors to ensure the most adequate functioning of these companies.
Exceeds Expectations
Meets Expectations
Below Expectations:
Comments:
2.
Promotes the continuity of the programs, establishes, and maintains acceptable relations with the public, as well as the professional community, while interpreting the activities of all related entities as stated in the missions and strategic plans.
Exceeds Expectations
Meets Expectations
Comments:
Below Expectations:

3 Administers all fiscal affairs of the organizations including but not limited to annual budgets and annual reports as they relate.
Exceeds Expectations
Meets Expectations
Below Expectations:
Comments:
3.
Administers all clinical and administrative affairs of the organizations including but not limited to the Annual Operating Plans of the companies.
Exceeds Expectations
Meets Expectations
Comments:
Below Expectations:

5. Oversees all environments of care and equipment matters.
Exceeds Expectations
Meets Expectations:
Below Expectations:
Comments:
6.
Provides overall leadership, direction and administration of the Agency
Foundation. Serves as an authorized representative of the
Board of Directors in all matters. Maintains organizational direction
through planning, goal setting and fundraising activities and
monitors results
Exceeds Expectations
Meets Expectations
Comments:
Below Expectations:

7.
Develops and implements Organizations Strategic Plan (Especially
Program Adaptations and Finance)
Exceeds Expectations
Meets Expectations
Below Expectations:
Comments:
8. Develops through the CFO the Organization Operating Plan for each fiscal year.
Exceeds Expectations
Meets Expectations
Comments:
Below Expectations:

9. Manages all Boards, Board Committees and goals.
Exceeds Expectations
Meets Expectations
Below Expectations:
Comments:
10. Conducts all professional activity in an ethical manner.
Exceeds Expectations
Meets Expectations
Comments:
Below Expectations:

11. Conforms to all applicable Parent Company and other related companies’ policies and procedures.
Exceeds Expectations
Meets Expectations
Below Expectations:
Comments:
12. Performs other duties as may from time to time be required and directed by the board.
Exceeds Expectations
Meets Expectations
Comments:
Below Expectations: